22. European Stroke Conference 155 Interesting and challenging cases Style-carotid syndrome as an exceptional cause of hemodynamic TIA A. Galiana-Ivars1, L. Hernández-Echebarría2, O. Balboa-Arregui3, L. Dominguez4, J. Teja-da- García5, S. Fernández-Menéndez6, L. Redondo-Robles7, R. García-Santiago8, N. González- Nafría9, F. Fernández-López10 Complejo Asistencial Universitario de León. Neurology Service., León, SPAIN1, Complejo Asistencial Universitario de León. Neurology Service, León, SPAIN2, Complejo Asistencial Uni-versitario de León. Radiology Service, León, SPAIN3, Complejo Asistencial Universitario de León. Maxillofacial Surgery Service, León, SPAIN4, Complejo Asistencial Universitario de León. Neurol-ogy Service, León, SPAIN5, Complejo Asistencial Universitario de León. Neurology Service, León, SPAIN6, Complejo Asistencial Universitario de León. Neurology Service, León, SPAIN7, Complejo Asistencial Universitario de León. Neurology Service, León, SPAIN8, Complejo Asistencial Univer-sitario de León. Neurology Service. León, SPAIN9, Complejo Asistencial Universitario de León. Neurology Service. León, SPAIN10 Background: Eagle syndrome is a rare clinical condition characterized by episodes of facial or oro-pharyngeal pain. Its cause is an extension and calcification of the styloid process or style-hyoid ligament. It’s exceptional that medial deviation of the styloid causes a compression of the internal carotid artery. This situation is called style-carotid syndrome and is rarely associated with the onset of TIAs. Methods: We report the case of a 71 years old man with diabetes, effort angina and atherothrombotic stroke in left centrum semiovale as past medical history. He presented numerous episodes of blurred vision and numbness in right arm. These episodes are evident with flexion and left cervical rotation. The ancillary tests reveal a critical atheromatous stenosis of the right internal carotid artery and sig-nificant dynamic compression of the left internal carotid artery by the existence of a mega-left sty-loid process. Assessed by the maxillofacial surgery department, they undergo a section of the distal portion of the styloid process with patient asymptomatic at discharge. Conclusion: Eagle syndrome has been known since 1937, when an otolaryngologist, Watt W. Eagle, described the first cases. This syndrome was characterized by symptoms typically occurring after pharyngeal trauma or tonsillectomy. An elongated styloid process occurs in about 4% of the gen-eral population, while only a small percentage of these patients are symptomatic. The stylocarotid syndrome is characterized by the compression of the internal or external carotid artery by a laterally or medially deviated styloid process. In case of impingement of the internal carotid artery, it is ex-ceptional when the clinical picture is a hemodynamic TIA, with few cases reported. However, even when clinical suspicion is low, we advocate a radiodiagnostic assessment of bony structures adjacent to vascular structures in transient ischemic processes with clear hemodynamic profile. 364 © 2013 S. Karger AG, Basel Scientific Programme 156 Interesting and challenging cases Bilateral dissection of carotid arteries as a first sign of fibromuscular dysplasia in an asymp-tomatic young patient D. Athanasopoulos1, V. Fardis2, E. Papageorgiou3, M. Gryllia4, S. Tsiara5 Neurology department, General Hospital of Athens, Athens, GREECE1, Neurology department, General Hospital of Athens, Athens, GREECE2, Neurology department, General Hospital of Athens, Athens, GREECE3, Neurology department, General Hospital of Athens, Athens, GREECE4, Neurol-ogy department, General Hospital of Athens, Athens, GREECE5 Background: A young man (34) comes to the ED - conscious with left hemiparesis and blurred vi-sion of the right eye presented at awakening. His individual and family medical history for cerebro-vascular events, hypertension and connective tissue disorders is free. Drug abuse was denied. The patient reported that he lifted heavy object under considerable pressure 24 hours before .His vital signs were normal. No malformations of the body or skin were reported or detected. Brain CT scan was performed which showed infract of RMCA territory. He underwent duplex ultrasound of neck arteries that showed right internal carotid artery dissection. The myocardial ultra sound and ECG were normal. His chest X-ray, biochemical and blood tests were also normal. Brain CTA was also performed which showed bilateral dissection of carotid arteries and severe stenosis of RVA. These findings were confirmed with magnetic resonance and digital subtraction angiography and addition-ally these tests gave the diagnosis of FMB. Laboratory findings were negative for connective tissue disease or vasculitis. For 4 days he received i.v. heparine 22.000 IU and subsequently ASA He re-covered within 3 days and he was released after 7 days Conclusion: Internal carotid artery dissection is a common cause of stroke in young patients with-out vascular risk factor, but bilateral is uncommon. Whilst some dissections occur in patients with known genetic predisposing factors ( Marfin’s syndrome, Ehlers-Danlos syndrome, polycystic kid-neys, FMB, Lob stein syndrome) many are either caused by direct neck trauma or precipitated by an event involving head or neck movement. FMB often occurs in young Caucasian women and as a first symptom is hypertension. So bilateral dissection as a first symptom of FMB in an asymptomatic man patient is even less common. Key words: bilateral dissection, fibromuscular dysplasia (FMB)
Karger_ESC London_2013
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