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Double or nothing: red flag symptoms of critical carotid stenosis, a case report

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ABSTRACT

Background: Detailed knowledge of every possible manifestation of Internal Carotid Artery (ICA) disease is important. For improving detection and a timely adoption of secondary prevention procedures or treatments. Transient oculomotor nerve palsies have been described associated with stenosis or occlusion of the ICA.

Case presentation: We described a patient that develop a sequential combination of transient monocular loss of vision followed by binocular diplopia secondary to an unstable atherosclerotic preocclusive stenosis of an internal carotid artery previously treated with radiotherapy.

Conclusions: The peculiar sequence of transient monocular vision that give rise later into a transient binocular diplopia (double or nothing) should be kept in mind as a possible manifestation of critical stenosis of ICA.

No MeSH data available.


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Diffusion MR Image showing hemispheric left focal hyperintensity area after the symptomatology and angiographic images showing left extracranial ICA critical stenosis before and after endovascular recanalization
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Fig1: Diffusion MR Image showing hemispheric left focal hyperintensity area after the symptomatology and angiographic images showing left extracranial ICA critical stenosis before and after endovascular recanalization

Mentions: Cranial magnetic resonance (MR) and MR angiography of the supra-aortic trunks showed an acute infarct on the left lentiform nucleus (Fig. 1), as well as a 95% and 60% stenosis of the left and right ICA respectively. MR cuts including the midbrain and orbit are shown in Fig. 2. These carotid stenosis were confirmed on digital subtraction angiography (DSA), an occlusion was observed in the ICA from its origin. The circulation of the left internal carotid artery came from collateral flow through the anterior communicating artery. The left ophthalmic artery blood supply was obtained through the anterior communicating artery of the circle of Willis and flow reversal of the left anterior cerebral artery (Fig. 3). The ophthalmic artery is a branch of the internal carotid artery. Carotid balloon angioplasty and the placement of an endoprosthesis with embolic protection system (The Carotid Wallstent Monorail Endoprosthesis with the Boston Scientific embolic protection system type FilterWire EZ™, and diameter guidewire of 0.014 in - 0.36 mm-) on the left ICA were performed without complications (Fig. 1). During 8 weeks after the surgery the patient was under double antiplatelet regimen with clopidogrel 75 mg/day and acetylsalicylic acid 300 mg/ day. Thereafter he has been under single treatment with acetylsalicylic acid 300 mg/day. After a 3 year follow up, the patient has not suffered any new symptom. Control sonographic studies have confirmed the permeability of the operated artery.Fig. 1


Double or nothing: red flag symptoms of critical carotid stenosis, a case report
Diffusion MR Image showing hemispheric left focal hyperintensity area after the symptomatology and angiographic images showing left extracranial ICA critical stenosis before and after endovascular recanalization
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5382405&req=5

Fig1: Diffusion MR Image showing hemispheric left focal hyperintensity area after the symptomatology and angiographic images showing left extracranial ICA critical stenosis before and after endovascular recanalization
Mentions: Cranial magnetic resonance (MR) and MR angiography of the supra-aortic trunks showed an acute infarct on the left lentiform nucleus (Fig. 1), as well as a 95% and 60% stenosis of the left and right ICA respectively. MR cuts including the midbrain and orbit are shown in Fig. 2. These carotid stenosis were confirmed on digital subtraction angiography (DSA), an occlusion was observed in the ICA from its origin. The circulation of the left internal carotid artery came from collateral flow through the anterior communicating artery. The left ophthalmic artery blood supply was obtained through the anterior communicating artery of the circle of Willis and flow reversal of the left anterior cerebral artery (Fig. 3). The ophthalmic artery is a branch of the internal carotid artery. Carotid balloon angioplasty and the placement of an endoprosthesis with embolic protection system (The Carotid Wallstent Monorail Endoprosthesis with the Boston Scientific embolic protection system type FilterWire EZ™, and diameter guidewire of 0.014 in - 0.36 mm-) on the left ICA were performed without complications (Fig. 1). During 8 weeks after the surgery the patient was under double antiplatelet regimen with clopidogrel 75 mg/day and acetylsalicylic acid 300 mg/ day. Thereafter he has been under single treatment with acetylsalicylic acid 300 mg/day. After a 3 year follow up, the patient has not suffered any new symptom. Control sonographic studies have confirmed the permeability of the operated artery.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Detailed knowledge of every possible manifestation of Internal Carotid Artery (ICA) disease is important. For improving detection and a timely adoption of secondary prevention procedures or treatments. Transient oculomotor nerve palsies have been described associated with stenosis or occlusion of the ICA.

Case presentation: We described a patient that develop a sequential combination of transient monocular loss of vision followed by binocular diplopia secondary to an unstable atherosclerotic preocclusive stenosis of an internal carotid artery previously treated with radiotherapy.

Conclusions: The peculiar sequence of transient monocular vision that give rise later into a transient binocular diplopia (double or nothing) should be kept in mind as a possible manifestation of critical stenosis of ICA.

No MeSH data available.


Related in: MedlinePlus