title: [Idiopathic vasospastic angiopathy of the internal carotid arteries: A rarely recognized cause of ischemic stroke in young individuals].
abstract: BACKGROUND
  Idiopathic vasospastic angiopathy of the internal carotid arteries is a rare and largely unknown cause of ischemic stroke.
  
  
  METHODS
  We report the case of a 39-year-old man with migraine treated by beta-blockers, who had been suffering from progressive right visual impairment and headache for one week. He then experienced a seizure and left hemiparesis. Ophthalmological examination revealed right retinal ischemia and partial left homonymous hemianopia. MRI revealed a long stenosis of both carotid arteries and a recent ischemic stroke in the territory of the right middle cerebral artery. The diagnosis of vasospastic angiopathy of the internal carotid arteries was made based on a second MRI and colored duplex sonography which showed a decrease in the stenosis and no intraparietal hematoma confirming the vasospasm mechanism for stenosis. The clinical course was favorable with calcium channel blockers and aspirin. Use of vasoconstrictor treatments was contraindicated.
  
  
  CONCLUSIONS
  Idiopathic vasospastic angiopathy of the internal carotid arteries has been rarely documented. Association with migraine has been mentioned but remains unclear in the literature. This etiology for stroke is probably under-diagnosed due to lack of rapid and repeated examinations of the cervical arteries (angio-MR and colored duplex sonography) to confirm the vasospasm mechanism. Recurrences have been reported justifying a specific secondary preventive treatment to induce vasodilatation. Vasoconstrictor treatments should be contraindicated.
authors.affiliation: Service de neurologie, CHU Besançon, hôpital Jean-Minjoz, 25000 Besançon, France. eloi.magnin@laposte.net
authors.forename: E
authors.initials: E
authors.lastname: Magnin
authors.forename: S
authors.initials: S
authors.lastname: Mouton
authors.forename: L
authors.initials: L
authors.lastname: Abouaf
authors.forename: S
authors.initials: S
authors.lastname: Dumas-Stoeckel
authors.forename: M
authors.initials: M
authors.lastname: Hermier
authors.forename: C
authors.initials: C
authors.lastname: Tilikete
authors.forename: A
authors.initials: A
authors.lastname: Vighetto
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002545:Brain Ischemia / Q000150:complications* / Q000188:drug therapy; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D016893:Carotid Stenosis / Q000150:complications* / Q000188:drug therapy; D002533:Cerebral Angiography; D006423:Hemianopsia / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000209:etiology; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008881:Migraine Disorders / Q000209:etiology; D010291:Paresis / Q000209:etiology; D012164:Retinal Diseases / Q000209:etiology; D012640:Seizures / Q000209:etiology; D020521:Stroke / Q000188:drug therapy / Q000209:etiology*; D018616:Ultrasonography, Doppler, Duplex; D020301:Vasospasm, Intracranial / Q000150:complications* / Q000188:drug therapy
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D002121:Calcium Channel Blockers; D001241:Aspirin