Vascular neck bruit in a teenager

Abstract

A healthy 16-year-old female presented to our internal medicine clinic with a 6-month history of dizziness and two fainting attacks within the past month. She mentioned feeling a buzzing noise in the left side of her neck, for which she sought medical advice. Physical examination revealed left carotid bruit but was otherwise unremarkable. Lipid profile and hypercoagulable screen

Carotid web and stroke

“…The angiographic appearance of this lesion is most akin to those described by Lipchik et al [2]. Qurash et al and Lenck et al have recently described similar diaphragm-like lesions, in which such concentric lesions were thought to be associated with a bruit and pulsatile tinnitus, respectively [3,4].…”

Endarterectomy for a symptomatic carotid web

“…Cases of carotid web in the current literature present with the signs and symptoms common to all patients suffering acute embolic stroke regardless of etiology. 1,2,5,6 Factors that raise the suspicion of FMD or non-atherosclerotic carotid from atherosclerosis can be considered based on age and gender, where FMD occurs more frequently in younger individuals and women. 4 Race appears to be an equivocal factor.…”

“…Traditional endarterectomy was performed in nearly all carotid web cases identified in the existing literature. [1][2][3][4][5][6][7] One notable exception was in a case where the web was identified in the vertebral artery, and the clinical team felt that the risk of surgical intervention was too high so the patient was treated with antiplatelet therapy. 3 Endarterectomy appears to be an effective treatment as several cases that reported outcomes suggested that the recovery was uneventful.…”

“…1 The histopathology of arterial webs appears to be different from that of atherosclerosis, lacking atheromatous changes and inflammation of the tunica intima. 2 However, the presence of the irregular, weblike formations poses a considerable risk for stroke and other ischemic events creating laminar flow disruption and irregular shear profile. 1 Several case reports describe moderate to severe short segment stenosis of up to 90% of the vessel lumen.…”

“…1 Several case reports describe moderate to severe short segment stenosis of up to 90% of the vessel lumen. [1][2][3][4][5][6][7]…”