Medical Registrar and basic physician trainee at Cairns hospital.
An Unusual Case Of Ischaemic Stroke With Carotid Web
Here we present the unusual case of a 46 year old caucasian lady who experienced a prolonged episode of amnesia and confusion with complete resolution. This occurred on a background of a pericallosal bleed secondary to intracranial aneurysm two years prior. Magnetic resonance imaging of the brain revealed an acute right frontal lobar ischaemic stroke. Investigations revealed several possible aetiologies including patent foramen ovale(PFO), positive lupus anticoagulant and an ipsilateral carotid web.
Carotid webs are non-atherosclerotic arterial wall abnormalities thought to be an intimal variant of fibromuscular dysplasia. They have recently been implicated as a rare cause of ischaemic stroke. Radiologically, they are defined as a shelf -like, intraluminal filling defect along the posterior wall of the carotid bulb and turbulence created by this defect acts as a nidus for thrombus formation. There is no clear consensus yet on their optimal management and trialled strategies include medical management, stenting or endarterectomy. Given the lack of consensus as well as the presence of PFO and possible antiphospholipid syndrome, we selected apixaban as secondary prevention of stroke for our patient.
The carotid web is an important and underappreciated potential cause of ischemic stroke in an otherwise healthy young person.