Patients with cystic medionecrosis may have a stroke due to short-track stenosis of the internal carotid artery.

There have been two reported cases of neuroleptic malignant syndrome (NMS) in combination with dysarthric disorders. In both cases the NMS was phenomenologically related to the malignant dopamine withdrawal syndrome and to the akinetic crisis of parkinsonism. The reported dysarthric disorders are to be interpreted as a differential-diagnostic sign of the exclusion of a permicious catatonia.

We report on the case of a 45-year-old man with stroke and progressive neurological symptoms. Duplex sonography showed an occlusion of the left common carotid artery as well as an open internal carotid artery due to retrograde flow from the external carotid artery into the internal carotid artery with pseudovenous flow. Transcranial duplex sonography showed a pseudovenous flow in the ipsilateral middle cerebral artery, because of insufficient intracranial collateralisation. During operative revascularisation, a primary shunt from the aortic arch to the internal carotid artery was necessary. After revascularisation, perfusion of the left middle cerebral artery was normal and the neurological symptoms abated. Revascularisation of a common carotid artery occlusion in case of progressive stroke may be indicated. The central position of the shunt and the surgical procedure described provide sufficient cerebral perfusion.