Abstract
A 21-year-old man presented with several episodes of ischemic attack involving the right extremities and speech. The first left carotid arteriogram revealed an embolic occlusion of the anterior ascending branch of the middle cerebral artery, although the left cervical internal carotid artery (ICA) appeared intact. Even after medical treatment, his neurological symptoms continued to deteriorate. At the second angiography carried out immediately after an episode of right hemiplegia and an amourosis of the left eye about one month later, a tapering occlusion of the left ICA was demon-strated, which was compatible with the findings of carotid arterial dissection. Hypervolemia and induced hypertension were started, and an occipital artery-middle cerebral artery anastomosis was performed 2 weeks after the final episode. Thereafter, he has been free of symptoms except for a mild expressive aphasia. Control angiography 8 months postoperatively demonstrated a complete occlusion of the left cervical ICA while the left hemisphere was well perfused through the bypass. Spontaneous internal carotid arterial dissection has become increasingly recongnized as a cause of cerebral ischemia, primarily in young patients. Although the benign nautre of the disease may indicate the use of noninvasive diagnositc tools and anticoagulant therapy, intensive care and surgical treatment will be mandatory for patients with progressive neurological deterioration, which is refractory to medical treatment as shown in this report.
