Fibromuscular dysplasia with carotid artery dissection presenting as an isolated hemianopsia.
BACKGROUND
Internal carotid artery (ICA) dissection is a well-known cause of anterior circulation stroke, but its association with posterior circulation stroke has been less commonly reported. The latter situation can arise when there is persistent fetal circulation of the posterior cerebral artery and has, to our knowledge, never been reported in the setting of fibromuscular dysplasia (FMD) involving the ICA.


METHODS
A 52-year-old man awoke with severe headache and noted visual loss. Examination confirmed a congruous left homonymous hemianopsia. A head computed tomography scan revealed an acute right posterior parietal infarct. Carotid ultrasonography demonstrated complete occlusion of the right ICA. Conventional angiography confirmed this and was diagnostic of FMD with dissection. A right-sided persistent fetal circulation was also noted. Magnetic resonance imaging revealed right parietal and right occipital infarctions.


RESULTS
The patient received ASA and clopidogrel and his visual deficit resolved within days. One year later, he remained asymptomatic and there was no suggestion of FMD in other vascular beds.


CONCLUSIONS
Although infrequently reported, carotid disease, including dissection, can be responsible for posterior circulation infarcts. Cervical artery dissection can be related to underlying arteriopathies such as FMD, which must be differentiated from vasculitis and vasospasm.
Poppe
Alexandre Y
AY
Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Minuk
Jeffrey
J
Glikstein
Raphael
R
Leventhal
Mark
M
D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging / Q000209:etiology*; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D000077144:Clopidogrel; D005352:Fibromuscular Dysplasia / Q000150:complications*; D006261:Headache / Q000209:etiology; D006423:Hemianopsia / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications; D007231:Infant, Newborn; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020326:Migraine without Aura / Q000150:complications; D010547:Persistent Fetal Circulation Syndrome / Q000150:complications*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D014463:Ultrasonography
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin