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22. European Stroke Conference 126 Interesting and challenging cases Eagle syndrome variant (Stylo-carotid syndrome) and bilateral internal carotid dissection S. Fontes1, J.E. Alves2, G. Lopes3, R. Felgueiras4 Neurology Department - Centro Hospitalar do Porto, Porto, PORTUGAL1, Neurorradiology Department - Centro Hospitalar do Porto, Porto, PORTUGAL2, Neurology Department - Centro Hospitalar do Porto, Porto, PORTUGAL3, Neurology Department - Centro Hospitalar do Porto, Por-to, PORTUGAL4 Bilateral carotid dissection not associated with external trauma is a rare event of undetermined eti-ology in some cases. One possible cause is the stylo-carotid variant of the Eagle´s syndrome, result of elongated styloid processes or calcified stylohyoid ligaments that may cause carotid arteries com-pression, most frequently after head turning or neck compression, and carotid dissection. This ana-tomical variant seems to occur in 4% of the population. A 35-year-old woman, with no significant personal or family medical history, initially presented with a spontaneous and progressive left cervical pain with occipital irradiation, unrelated to any ma-jor trauma or physical effort. During the following week, she had three episodes of sudden and re-versible blurred vision, lasting less than two hours. Two weeks after the initial symptoms, the patient presented a transient period of speech disturbance and labial commissure deviation. At the emergen-cy department the neurological examination was normal. The head CT scan revealed a small cortical infarct in the left post-central gyrus and the CT angiography showed classic bilateral internal carotid arteries dissection and extensive calcification of both the stylohyoid ligaments. Blood scan of auto-immunity was negative. The patient started hypocoagulation and, a month later, an abdominal, head and neck angiography showed complete recanalization of the internal carotid arteries and no renal or cerebral vascular abnormalities. The patient remained asymptomatic. We believe that Eagle’s syndrome contributed to this young healthy patient’s carotid bilateral dissec-tion. 348 © 2013 S. Karger AG, Basel Scientific Programme 127 Interesting and challenging cases Postpartum haemorrhage: the usefulness of angiography and transcranial duplex (TCD) in the diagnosis of vasoespasm. M. Terceño1, Y. Silva2, C. van Eendenburg3, J. Serena4, M. Castellanos5 Josep Trueta Hospital. Girona, Neurology Service, Girona, SPAIN1, Josep Trueta Hospital. Giro-na, Neurology Service, Girona, SPAIN2, Josep Trueta Hospital. Girona, Neurology Service, Girona, SPAIN3, Josep Trueta Hospital. Girona, Neurology Service, Girona, SPAIN4, Josep Trueta Hospital. Girona, Neurology Service, Girona, SPAIN5 Objective: To study the case of a 41-year-old women who presented a postpartum intracerebral hae-morrhage (ICH). Patients and methods: We describe a patient without relevant antecedents and with a complica-tion- free pregnancy requiring a caesarean section who, after an incident-free immediate postpartum period, presented intense neck pain and left-sided hemiparesis on the 6th day after delivery. Left homonymous hemianopsia, facial paresis, ipsilateral hemiplegia and hemihypoesthesia and dysar-thria were observed in the exploration. Cranial CT showed a 35 cc ICH in the right semi-oval centre and angioCT did not show vascular alterations. Results: Surgical evacuation was performed following neurological deterioration at 24 hours. Four days later right hemiparesis and motor aphasia appeared. A cerebral MRI found bilateral cortical ce-rebral infarctions in the territory of both MCAs and angiography revealed severe generalised vaso-spasms, which were confirmed by TCD (Lindegaard Index > 5). Intravenous nimodipine and statin treatment was initiated. Later the patient stabilised and progressive improvement of the vasoespasm was monitored daily by TCD over a two-week period without stroke recurrence. Discussion: We present the case of a patient with an ICH in the immediate postpartum period who later presented bilateral cerebral infarction and severe vasospasm observed by angioMRI and TCD which allowed the diagnosis of postpartum cerebral angiopathy (PCA). The absence of vasospasm in the angiography in the hyperacute phase does not exclude the diagno-sis of PCA as, on occasions, this becomes clear later on. For this reason, TCD is a useful tool given that it not only helps to monitor the patient but also makes early diagnosis possible so avoiding fur-ther vascular events. We argue that TCD should be included in the aetiological study of patients with ICH related to preg-nancy or the postpartum period.


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