title: Recurrent extracranial internal carotid artery vasospasm diagnosed by serial magnetic resonance angiography and superselective transarterial injection of a calcium channel blocker.
abstract: Recurrent vasospasm of the extracranial internal carotid artery (ICA) is extremely rare, and optimal management is unclear. A 25-year-old woman developed transient dysarthria and left-sided hemiparesis. Initial magnetic resonance (MR) imaging showed spotty acute infarction in the right temporal lobe, and MR angiography revealed right ICA occlusion. ICA occlusion was spontaneously resolved within 6 days of its onset, whereas transient left ICA narrowing was evident at 12 days. Because recurrent occlusion of the right ICA occurred at 14 days when the contralateral ICA was still narrowed, we attempted a local intra-arterial injection of a calcium channel blocker based on the diagnosis of recurrent extracranial ICA vasospasm. The local injection of 1 mg of nicardipine partially dilated the affected ICA, which confirmed the diagnosis of vasospasm. After the introduction of oral medication with benidipine hydrochloride, bilateral ICA vasospasm was completely resolved 23 days after its onset, as shown by MR angiography. In conclusion, we recommend intensive radiologic follow-up at the acute stage and therapeutic catheter angiography when the bilateral lesion is evident because bilateral occlusion of the ICA could lead to a catastrophic condition.
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan.
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Shimoda
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan. Electronic address: mfujimur@gmail.com.
authors.forename: Miki
authors.initials: M
authors.lastname: Fujimura
authors.affiliation: Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Kimura
authors.affiliation: Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ezura
authors.affiliation: Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Uenohara
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000328:Adult; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D002343:Carotid Artery, Internal / Q000187:drug effects / Q000503:physiopathology*; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D018810:Magnetic Resonance Angiography; D009529:Nicardipine / Q000008:administration & dosage*; D009543:Nifedipine / Q000008:administration & dosage / Q000031:analogs & derivatives; D011237:Predictive Value of Tests; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D014661:Vasoconstriction / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D002121:Calcium Channel Blockers; D014665:Vasodilator Agents; C050883:benidipine hydrochloride; D009529:Nicardipine; D009543:Nifedipine
keywords: Recurrent extracranial internal carotid artery vasospasm; calcium channel blocker; interventional neuroradiology; magnetic resonance angiography