Recurrent Strokes due to Transient Vasospasms of the Extracranial Internal Carotid Artery

Abstract

Vasospasms of the intracranial arteries are a well-known complication of subarachnoid hemorrhage and are also frequently encountered in other disorders such as migraine, cerebral vasculitis or reversible cerebral vasoconstriction syndrome. In contrast, recurrent spontaneous vasospasms of the extracranial circulation appear to be extremely rare and have most often been associated with migraine. We present a patient with recurrent strokes due to spontaneous transient vasospastic occlusions of the internal carotid artery (ICA) without migraine over a time period of at least 13 years. Initially, the patient had presented with a bilateral ICA occlusion and a cerebral infarct on the right side. While the right ICA remained occluded, a reopening of the left ICA could be detected 3 days after this initial event. In subsequent years, both duplex sonography and magnetic resonance angiography revealed recurrent occlusions of the left ICA, which resolved spontaneously within days. This case and other rare previous reports indicate that recurrent non-migrainous vasospasms of the extracranial carotid artery likely reflect a distinct entity which can cause ischemic strokes.

Thrombectomy for ischemic stroke: meta-analyses of recurrent strokes, vasospasms, and subarachnoid hemorrhages

“…especially, common after subarachnoid hemorrhage, or traumatic brain injury [10][11][12], and typically occur between 2 and 14 days after the primary event [12]. Finally, vasospasm can be a cause of (recurrent) ischemic stroke [13,14]. Hence, we conducted meta-analyses to (re)assess these outcomes.…”

Successful Corticosteroid Treatment of Refractory Spontaneous Vasoconstriction of Extracranial Internal Carotid and Coronary Arteries

“…Steroid therapy was effective in 2 cases 1 , 3 and ineffective in 1. 10 Takagi et al reported that, in some patients with an allergic tendency, their recurrent vasospastic angina was completely controlled by corticosteroids administration, and they have suggested that the coronary spasms may be induced by arterial hyperreactivity caused by local inflammation; corticosteroids would suppress the allergic response in the coronary artery. 13 Corticosteroids may also be effective in the SVEICA patients for the same reason.…”

Treatment challenges in idiopathic extracranial ICA vasospasm case report and review of the literature

“…There are earlier case reports of alternating hemiplegia or hemiplegic migraine; however, these were before reliable angiography and also concluded lack of effective treatment. All reported cases of extracranial vasospasm to date with their treatments and outcomes are summarized in Table 1 [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] ].…”

“…Edaravone (60 mg/day x 11 days) Worsening 3. IV Dexamethasone (12 mg/day, 5 days) Decorticate posturing, paradoxical breathing, cardiopulmonary arrest, death Wopking et al, 2013 [ 14 ] 34/F LICA followed by RICA 3 days later 1. CCB Nicardipine (240 mg/day) and Phenprocoumon Recurrence in 5 years 2.…”