Abstract
We report a case of spontancous dissection of the intracranial internal carotid artery with plasminogen abnormality. A 41-year-old woman suffered from weakness of her right upper extremity and narrowing of the visual field in her left eye. Branch occlusion of left retinal artery was disclosed, and brain MRI revealed multiple brain infarction in the territory of the left middle cerebral artery. Left carotid angiography demonstrated a string sign in the cavernous portion, suggesting dissection of the intracranial internal carotid artery. Following anticoagulation therapy, cerebral angiography showed recanalization, although reocclusion occurred 27 days later, and MRI delineated a double lumen in the petrosal-cavernous portion. Since the patient suffered from another brain infarction 10 months later, we performed position emission tomography which demonstrated matched hypoperfusion of cerebral blood flow and oxygne metabolsim. Biopsy of the frontal branch of the superficial temporal artery revealed a multi-laminated basal lamina, mild intimal thickening amorphous materials, and decreased collagen, which suggested systemic vascular disease. We therefore, treated the patient conservatively without bypass surgery. She was also a case of familial plasminogen abnormality, which might be associated with progressive thrombus formation after dissection of the intermal carotid artery.
