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(Stroke. 1998;29:1063-1066.)
© 1998 American Heart Association, Inc.

Case Report

Cervical Carotid Artery Vasospasms Causing Cerebral Ischemia

Detection by Immediate Vascular Ultrasonographic Investigation

Christian Arning, MD; Alexandra Schrattenholzer, MD; Lutz Lachenmayer, MD

From the Department of Neurology, Barmbek Hospital, Hamburg, Germany.

Correspondence to Dr Christian Arning, Abteilung Neurologie, Allgemeines Krankenhaus Barmbek, D-22291 Hamburg, Germany. E-mail christian.arning{at}t-online.de

Background—The etiology of cerebral ischemic accidents in young adults often remains unclarified.

Case Description—A 32-year-old woman presented after multiple episodes of left monocular visual impairment and right-sided focal signs. MRI revealed a low-flow infarction on the left; color-coded duplex sonography (CCDS), however, showed normal vascular findings. During the inpatient rehabilitation, a renewed visual impairment occurred; an immediate CCDS examination now demonstrated a filiform stenosis of the left internal carotid artery (ICA) 4 cm above the origin and indirect signs of a severe stenosis of the right ICA. Results of a follow-up examination 18 hours later were again normal. Six weeks later, on reoccurrence of visual impairment, a reversible stenosis of the left ICA was again demonstrated. A search for possible causes of vasospasm was unsuccessful. After treatment with calcium antagonists the patient was free of complaints (with the exception of 3 very short attacks of visual impairment) during the following 12 months.

Conclusions—Cervical carotid artery vasospasms can apparently occur spontaneously without a mechanical trigger. Because their detection is difficult, vasospasms may go undetected.

Key Words: carotid arteries • cerebral ischemia • ultrasonics • vasospasm • young adults

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