Naslov
A spontaneous carotid artery dissection in a ballet dancer ; A case report

Autori
Črnac, Petra ; Meter, Mijo ; Sedlić, Marija ; Milošević, Marina ; Budinčević, Hrvoje

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, ostalo

Izvornik
57th International Neuropsychiatric Pula Congress - Abstract book / - , 2017, 93-94

Skup
57th International Neuropsychiatric Congress

Mjesto i datum
Pula, Hrvatska, 24.05.2017. - 27.05.2017

Vrsta sudjelovanja
Poster

Vrsta recenzije
Podatak o recenziji nije dostupan

Ključne riječi
spontaneous carotid artery dissection ; Doppler ultrasound

Sažetak
Introduction: Cervicocerebral arterial dissections (CAD) account for nearly 20% of strokes in patients under the age of 45, therefore they are an important cause of stroke in young adults. Most CADs are considered ‘spontaneous’, although pre-existing disorders of the arterial wall and trauma are the main predisposing factors. It is important to recognise and treat this syndrome because of a relatively benign course and potentially excellent outcome in most patients. We describe a case where a definite temporal correlation was present between neck movement, trivial trauma and acute arterial dissection. Case report: We present the case of a 48-year old professional male ballet dancer with a spontaneous right internal carotid artery dissection presented as transient leftsided weakness, right-sided tinnitus and blurry vision in his right eye, following intense jerky head movements during dancing. The initial neurological examination revealed right side Horner syndrome. The initial head CT was negative. He was subsequently admitted to the Stroke unit and referred for a color Doppler flow imaging revealing a subintimal hematoma in the proximal part of the right internal carotid artery and reverse flow in the right ophthalmic artery. Transcranial doppler showed markedly reduced hemodynamic in the right middle cerebral artery. Head MRI revealed multiple acute ischemic lesions (emboli) in right frontal regions, basal ganglia, external capsule and knee of the internal capsule. MR angiography of the head and neck revealed narrowing and stenosis of the right carotid artery, with pathological morfological changes from the bifurcation to the intracranial part of the artery beneath the pyramid, suggestive of dissection. Laboratory findings revealed hyperlipidemia and elevated liver enzymes. The patient was treated with antiplatelet, antihypertensive and hypolipidemic agents, as well as physical therapy. After hospital discharge, a carotid ultrasound follow-up 14 days after through the outpatient clinic revealed the persistence of the subintimal hematoma, but the blood flow through all studied arteries was now physiological. At five-month follow-up, neurological examination was unremarkable except for slight right eyelid ptosis. Carotid color Doppler imaging showed complete resorption of the subintimal hematoma with physiological hemodynamics in all studied arteries. Conclusion: There seems to be an important association between neck movements, minor non-penetrating neck trauma and trivial neck torsion precipitating carotid dissection. Whether `spontaneous' dissections are truly spontaneous or effect of forgotten indirect neck trauma is questionable. A review of the literature shows that in many 'spontaneous' dissections, a history of abnormal neck movement, minor trauma or exercise was present. A history of such subtle precipitating events should be taken while diagnosing young patients with stroke. Sometimes the causal potential trauma antecedates immediately the initial symptoms of dissection and there is a definitive temporal correlation, but sometimes the onset of dissection may precede the clinical symptoms by hours or days and it might loosen the association between the two. Hyperextension of the neck has been considered as an important precipitating factor, particularly in the presence of inherent vessel wall abnormalities. By an early identification and treatment, particularly in high-risk patients, it is possible to reduce the incidence of stroke secondary to carotid dissection. Carotid Doppler ultrasound is a noninvasive, accessible and prompt imaging method and has a central role in the assessment of midcervical carotid artery dissections.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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