Cervical carotid artery vasospasms causing cerebral ischemia: detection by immediate vascular ultrasonographic investigation.
BACKGROUND
The etiology of cerebral ischemic accidents in young adults often remains unclarified.


METHODS
A 32-year-old woman presented after multiple episodes of left monocular visual impairment and right-sided focal signs. MRI revealed a low-flow infarction on the left; color-coded duplex sonography (CCDS), however, showed normal vascular findings. During the inpatient rehabilitation, a renewed visual impairment occurred; an immediate CCDS examination now demonstrated a filiform stenosis of the left internal carotid artery (ICA) 4 cm above the origin and indirect signs of a severe stenosis of the right ICA. Results of a follow-up examination 18 hours later were again normal. Six weeks later, on reoccurrence of visual impairment, a reversible stenosis of the left ICA was again demonstrated. A search for possible causes of vasospasm was unsuccessful. After treatment with calcium antagonists the patient was free of complaints (with the exception of 3 very short attacks of visual impairment) during the following 12 months.


CONCLUSIONS
Cervical carotid artery vasospasms can apparently occur spontaneously without a mechanical trigger. Because their detection is difficult, vasospasms may go undetected.
Arning
C
C
Department of Neurology, Barmbek Hospital, Hamburg, Germany. christian.arning@t-online.de
Schrattenholzer
A
A
Lachenmayer
L
L
D000328:Adult; D002340:Carotid Artery Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging* / Q000209:etiology*; D013035:Spasm / Q000150:complications / Q000000981:diagnostic imaging; D018615:Ultrasonography, Doppler, Color; D018616:Ultrasonography, Doppler, Duplex