London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 363 153 Interesting and challenging cases Cervical internal carotid artery dissection as a cause of ischemic stroke in a violin player- is there a connection? S.R. Djokovic1, N. Basurovic2, T. Jaramaz Ducic3, M. Vukicevic4, S. Trajkovic Bezmarevic5, I. Gr-kic6, B. Georgievski Brkic7, G. Milenkovic8 Special Hospital for Cerebrovascular Disease “ Sveti Sava”, Belgrade, SERBIA1, Special Hos-pital for Cerebrovascular Disease “ Sveti Sava”, Belgrade, SERBIA2, Special Hospital for Cerebro-vascular Disease “ Sveti Sava”, Belgrade, SERBIA3, Special Hospital for Cerebrovascular Disease “ Sveti Sava”, Belgrade, SERBIA4, Special Hospital for Cerebrovascular Disease “ Sveti Sava”, Bel-grade, SERBIA5, Special Hospital for Cerebrovascular Disease “ Sveti Sava”, Belgrade, SERBIA6, Special Hospital for Cerebrovascular Disease “ Sveti Sava”, , 7, Special Hospital for Cerebrovascu-lar Disease “ Sveti Sava”, Belgrade, SERBIA8 Background: Carotid artery dissection, spontaneous or as a result of minor or major trauma, is a sig-nificant cause of stroke in young patients. We describe a patient, violinist, with acute stroke because of carotid dissection. Case report: A 43-year-old, previously healthy, man presented to the emergency department with sudden onset of confusion, vision loss and right sided weakness, without history of neck trauma. He complained of preceding severe left- sided headache and ipsilateral neck pain. One day before the stroke he was playing the violin for several hours holding the violin on his left shoulder. His baseline vital signs were stabile. He had mild right hemiparesis and right homonymous hemianopia. Emergency CT brain scan revealed acute infarction in the left parietooccipital lobe. Dopler ultra-sound showed occluded left internal carotid artery and other neck blood vessels were normal. Mag-netic resonance angiography of neck and head revealed signs of carotid dissection 15 mm distal to the carotid bifurcation and left internal carotid artery occlusion secondary to dissection. The left posterior cerebral artery has fetal origin and was occluded suggesting distal embolisation. The pa-tient was admitted in stroke unit and treated with anticoagulants. A systemic examination and inves-tigation failed to find any underlying condition that might have predisposed him to artery dissection. He made partially progress and was discharged with right homonymous hemianopia. Two month lat-er the patient neurological examination was unchanged. Follow-up Dopler ultrasound and magnetic resonance angiogram was done then and did not show resolution of the carotid artery. Conclusion: We did not find other causes of dissection so we thought that minor trauma as a long playing the violin could cause cervical carotid artery dissection and ischemic stroke in our patient or the dissection was a spontaneous accident. 154 Interesting and challenging cases EC-IC bypass following intracerebral haemorrhage from collateral vessels M.O. McCarron1, J. McKee2, P.A. Flynn3, P.J. Kirkpatrick4 Altnagelvin Neurology Centre, Derry, UNITED KINGDOM1, Acute Stroke Service, Altnagelvin Hospital, Derry, UNITED KINGDOM2, Royal Victoria Hospital, Belfast, UNITED KINGDOM3, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UNITED KINGDOM4 Background EC/IC bypass can improve cerebrovascular reserve in patients with symptomatic cerebral ischaemia in the presence of occlusive carotid disease. Methods A 54 year old woman who smoked cigarettes and had a history of rheumatoid arthritis developed pulsatile tinnitus in March 2011. One year later after defecating, she developed a sudden and very severe onset of neck pain. She had no neurological deficit. Results CT scan of brain revealed haemorrhage in the corpus callosum with subarachnoid haemorrhage and intraventricular haemorrhage. CT Angiogram revealed an occluded left internal carotid artery. A pre-vious MRI scan of brain showed left hemisphere ischaemia and collateral vessels in the corpus cal-losum. Subsequent MR perfusion scan showed decreased cerebrovascular reserve in the left hemi-sphere. An EC/IC bypass procedure was performed with subjective global improvement in thinking and energy. Literature review: Moyamoya disease-like vessels have been documented in intracranial haemor-rhage in two patients with internal carotid artery occlusion; both cases were also revascularised. Conclusion Revascularization in patients with intracranial haemorrhage presumed from collateral vessels fol-lowing ICA occlusion subjectively helped our patient. Further research is required to determine whether EC/IC bypass can reduce rebleeding risk.
Karger_ESC London_2013
To see the actual publication please follow the link above