Ischemic stroke due to spontaneous reversible extra-cranial internal carotid artery vasospasm: A case report

Abstract

Reversible idiopathic extracranial internal carotid artery (ICA) vasospasm is a rare cause of ischemic stroke especially seen among young patients and the pathophysiology is not fully understood. We report here a 23-year-old female who presented with left hemiparesis and hemihypoesthesia. She had several similar reversible attacks which last about 30 minutes in the past years. She had migraine-type headaches five times a month and history of bipolar disease. MRI showed multiple infarction areas on the right middle cerebral artery (MCA) territory with no large vessel abnormality. We could not find any cardioembolic or other etiology except for a PAI-1 heterozygote 4G/5G mutation. She was given warfarin and had several ischemic attacks in different vascular areas in the following years with various treatment strategies. MR angiography showed reversible stenosis of both internal carotid arteries (ICA) in every attack with different severities. We diagnosed the patient as reversible vasoconstriction syndrome of the ICA and started prednisolone, nimodipine, and ASA treatment. In conclusion, spontaneous reversible extracranial internal carotid artery vasospasm is a rare condition with uncertain pathology. There is also no effective treatment.