Abstract Details

Title Spontaneous Consecutive Four Vessel Cervicocephalic Dissections and Flow-Limiting Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-058

Objective To report a rare case of a patient with initial left carotid artery dissection (CAD) resulting in ischemic stroke with subsequent right carotid and bilateral vertebral artery dissections (VAD).

Background

Up to 1 in 4 strokes in young adults are related to dissections with roughly two-thirds being spontaneous and ≤15% being multivessel. However, cases of subsequent spontaneous dissection in all cervical arteries are exceedingly rare. Moreover, the majority of ischemic strokes from CAD are thromboembolic in nature. In patients with significant flow-limiting stenosis, ischemia from hypoperfusion, particularly in watershed territories, can be observed.

Design/Methods Case report.

Results A 41-year-old woman with history of Crohn’s disease and use of oral contraceptives presented with headache and right sided weakness. Initial MRI demonstrated ischemic strokes in the left middle cerebral artery/anterior cerebral artery and middle cerebral artery/posterior cerebral artery watershed territories secondary to left CAD with severe narrowing of the cervical and petrous portion. CT perfusion showed a large ischemic penumbra at risk for ischemia. She was started on heparin infusion and admitted to the ICU for augmentation of blood pressure to improve perfusion. During her hospitalization, she did progress to complete occlusion of the left carotid artery and expansion of watershed stroke despite aggressive medical therapy. She also developed subsequent small symptomatic right CAD as well as asymptomatic bilateral VAD and aspirin was added. With continued treatment, however, she did not develop more strokes and made a favorable clinical recovery.

Conclusions Spontaneous CAD is a common etiology for ischemic stroke in the young. Although very rare and processes are unclear, subsequent dissections in other cervicocephalic arteries are possible presenting both diagnostic and therapeutic challenges, given the mechanisms of ischemic stroke including flow-limitations and the value of perfusion imaging in guiding treatment.

Authors/Disclosures
Anvi Gadani, MD PRESENTER	No disclosure on file
Ilavarasy Maran, MD (Trillium Health Partners)	Dr. Maran has nothing to disclose.
Amre Nouh, MD, FAAN (Cleveland Clinic)	Dr. Nouh has stock in Openwater.

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