Cerebral infarct with idiopathic cervical internal carotid artery vasospasm: A case report and literature review

Abstract

Intracranial vasospasm that results from subarachnoid hemorrhage mostly leads to cerebral infarct. On the other hand, cervical internal carotid artery (CICA) vasospasm is caused by various factors such as cervical surgery, taking ergotamine, or is of unknown origin. We report here a rare case of cerebral infarct due to repeated idiopathic bilateral CICA vasospasm, and present a review of the literature. A 38-year-old man, who had a medical history of cerebral infarcts at the ages of 27 and 35, was admitted complaining of disturbance of consciousness and aphasia. MRI and MRA revealed cerebral infarct of the left middle cerebral artery (MCA) area due to occlusion of the left cervical internal carotid artery. Cerebral angiography at 9 days after onset, we demonstrated that the right CICA was occluded, whereas the left CICA was recanalized. On the 32nd day after onset, MRA showed the bilateral CICA to be recanalized. Idiopathic CICA vasospasm should be considered as a cause of juvenile-onset cerebral infarct. Regular follow-up is therefore needed because idiopathic CICA vasospasm is prone to recurrence. Keywords: Cervical internal carotid artery vasospasm, Juvenile-onset cerebral infarct, Internal carotid artery dissection, Fibromuscular dysplasia, Rho kinase inhibitor