Introduction: Carotid web (CW), a rare and probably unknown arterial cause of ischemic stroke (IS), is commonly reported in young black patients, although most of the published cases resided in a non-African country. ...Introduction: Carotid web (CW), a rare and probably unknown arterial cause of ischemic stroke (IS), is commonly reported in young black patients, although most of the published cases resided in a non-African country. We describe the features of the first six Senegalese cases diagnosed at the Neurology Department of the Fann Teaching Hospital in Dakar. Patients and Method: It was a preliminary retrospective and prospective study conducted at the Neurology department of Fann teaching hospital (Dakar-Senegal). The symptomatic CW diagnosis was based on angioCT-scan of the neck arteries. The National Institute of Health Stroke Scale (NIHSS) and the modified-Rankin Scale (mRS) were used to assess the severity of the IS and the functional disability after the event, respectively. Results: CW was causing a left sylvian infarction in 4 patients. The mean age of the patients at the IS diagnosis was 41 ± 6 years with a sex ratio of 1. The mean time to diagnosis of CW was 13 months. Smoking (1/6), hypertension (1/6), and obesity (1/6) were the main vascular risk factors. The mean LDL cholesterol level was 1.52 g/L ± 0.49. The mean initial NIHSS was 15 ± 6 (8-22). Half of the patients had a severe infarction (NIHSS ≥ 15). For secondary prevention, half of the patients were treated with aspirin and the other half with acenocoumarol. After 18 months ± 17 of follow-up, the mean mRS score was 2 ± 1 (1-3). Conclusion: CW is an unknown cause of IS in young black patients. An early and appropriate multidisciplinary management could help to reduce the risk of recurrences.展开更多
One third of ischemic strokes have no known cause, and basic understanding of the mechanisms of these “cryptogenic” strokes is lacking. However, observational studies are increasingly bringing to light an etiology t...One third of ischemic strokes have no known cause, and basic understanding of the mechanisms of these “cryptogenic” strokes is lacking. However, observational studies are increasingly bringing to light an etiology that has long remained hidden, the carotid web. The authors report a case of carotid web in a 32-year-old patient, gardener, from sub-Sharan Africa, with no medical history or known cerebrovascular risk factors. Indeed, due to a sudden weakness of his left limbs, the MRI was performed and revealed an ischemic stroke positive on diffusion-weighted within the territory of the right middle cerebral artery. FLAIR sequences were normal, while T<sup>2</sup>* sequences revealed an M1 thrombus ipsilateral to the brain lesion. After thrombolysis and thrombectomy, the patient’s weakness improved significantly. Digital subtraction angiography of supra-aortic trunks revealed the carotid web, which was incriminated as the etiology of this ischemic stroke in the absence of any abnormality on the other ancillary examinations that were performed. To prevent a recurrence, the patient was given Aspegic 250 mg/day and received physical therapy. The clinical course was improved and at 3 months, there was no new cerebrovascular event and his Rankin score was 1.展开更多
A carotid web is considered a localized form of fibromuscular dysplasia,carrying a heightened risk of stroke due to blood stagnation and subsequent clot formation downstream from the web.These abnor-malities typically...A carotid web is considered a localized form of fibromuscular dysplasia,carrying a heightened risk of stroke due to blood stagnation and subsequent clot formation downstream from the web.These abnor-malities typically affect the rear outer wall of the carot-id artery,and their exact developmental origin remains a topic of debate.This case report details the presentation of a young male with altered mental status,ultimately di-agnosed with an acute stroke using magnetic resonance imaging(MRI).Brain MRI revealed an ischemic stroke affecting the distribution of the left middle cerebral artery(MCA),with linear filling defects resembling shelves in the carotid bulbs on a computed tomography angiogra-phy(CTA)of the head and neck,consistent with bilateral carotid web confirmed by catheter angiography.Bilateral carotid web cases are also relatively uncommon in clin-ical practice but should not be dismissed as a potential cause of unexplained strokes.Bilateral carotid webs were identified using head and neck CTA,cerebral angiogra-phy,and carotid artery Doppler ultrasound.The patient was then treated with enteric-coated aspirin,clopidogrel,and high-intensity statins,followed by carotid endarterec-tomy after a 2-month follow-up,revealing fibromuscular hyperplasia upon pathology examination.展开更多
文摘Introduction: Carotid web (CW), a rare and probably unknown arterial cause of ischemic stroke (IS), is commonly reported in young black patients, although most of the published cases resided in a non-African country. We describe the features of the first six Senegalese cases diagnosed at the Neurology Department of the Fann Teaching Hospital in Dakar. Patients and Method: It was a preliminary retrospective and prospective study conducted at the Neurology department of Fann teaching hospital (Dakar-Senegal). The symptomatic CW diagnosis was based on angioCT-scan of the neck arteries. The National Institute of Health Stroke Scale (NIHSS) and the modified-Rankin Scale (mRS) were used to assess the severity of the IS and the functional disability after the event, respectively. Results: CW was causing a left sylvian infarction in 4 patients. The mean age of the patients at the IS diagnosis was 41 ± 6 years with a sex ratio of 1. The mean time to diagnosis of CW was 13 months. Smoking (1/6), hypertension (1/6), and obesity (1/6) were the main vascular risk factors. The mean LDL cholesterol level was 1.52 g/L ± 0.49. The mean initial NIHSS was 15 ± 6 (8-22). Half of the patients had a severe infarction (NIHSS ≥ 15). For secondary prevention, half of the patients were treated with aspirin and the other half with acenocoumarol. After 18 months ± 17 of follow-up, the mean mRS score was 2 ± 1 (1-3). Conclusion: CW is an unknown cause of IS in young black patients. An early and appropriate multidisciplinary management could help to reduce the risk of recurrences.
文摘One third of ischemic strokes have no known cause, and basic understanding of the mechanisms of these “cryptogenic” strokes is lacking. However, observational studies are increasingly bringing to light an etiology that has long remained hidden, the carotid web. The authors report a case of carotid web in a 32-year-old patient, gardener, from sub-Sharan Africa, with no medical history or known cerebrovascular risk factors. Indeed, due to a sudden weakness of his left limbs, the MRI was performed and revealed an ischemic stroke positive on diffusion-weighted within the territory of the right middle cerebral artery. FLAIR sequences were normal, while T<sup>2</sup>* sequences revealed an M1 thrombus ipsilateral to the brain lesion. After thrombolysis and thrombectomy, the patient’s weakness improved significantly. Digital subtraction angiography of supra-aortic trunks revealed the carotid web, which was incriminated as the etiology of this ischemic stroke in the absence of any abnormality on the other ancillary examinations that were performed. To prevent a recurrence, the patient was given Aspegic 250 mg/day and received physical therapy. The clinical course was improved and at 3 months, there was no new cerebrovascular event and his Rankin score was 1.
文摘A carotid web is considered a localized form of fibromuscular dysplasia,carrying a heightened risk of stroke due to blood stagnation and subsequent clot formation downstream from the web.These abnor-malities typically affect the rear outer wall of the carot-id artery,and their exact developmental origin remains a topic of debate.This case report details the presentation of a young male with altered mental status,ultimately di-agnosed with an acute stroke using magnetic resonance imaging(MRI).Brain MRI revealed an ischemic stroke affecting the distribution of the left middle cerebral artery(MCA),with linear filling defects resembling shelves in the carotid bulbs on a computed tomography angiogra-phy(CTA)of the head and neck,consistent with bilateral carotid web confirmed by catheter angiography.Bilateral carotid web cases are also relatively uncommon in clin-ical practice but should not be dismissed as a potential cause of unexplained strokes.Bilateral carotid webs were identified using head and neck CTA,cerebral angiogra-phy,and carotid artery Doppler ultrasound.The patient was then treated with enteric-coated aspirin,clopidogrel,and high-intensity statins,followed by carotid endarterec-tomy after a 2-month follow-up,revealing fibromuscular hyperplasia upon pathology examination.
