Recurrent Acute Ischemic Stroke Associated with Dolichoectatic Aneurysm of the Internal Carotid Artery.

Abstract

BACKGROUND:

Cranial artery dolichoectasia is characterized by dilated, elongated, and tortuous cranial arteries. Dolichoectasia and dolichoectatic aneurysm-particularly of the internal carotid arteries (ICAs)-are rare but can lead to stroke. We report a case of suspected recurrent acute cerebral infarction and dolichoectatic aneurysm of the left ICA combined with right dolichoectatic aneurysm, vertebrobasilar dolichoectasia, and atrial fibrillation.

CASE DESCRIPTION:

An 80-year-old man experienced 3 days of recurrent aphasia episodes. He had a history of atrial fibrillation and hypertension. Neurologic findings indicated Wernicke aphasia. Magnetic resonance imaging showed acute cerebral infarction in the left temporal and parietal lobes. Magnetic resonance angiography and cerebral angiography showed dolichoectatic aneurysms in the C1-2 portion of the bilateral ICAs and vertebrobasilar dolichoectasia. Possible diagnoses included convulsion, cardioembolic infarction, atherothrombotic cerebral infarction, and acute ischemic stroke associated with the dolichoectatic aneurysm of the left ICA. Oral antiplatelet drugs, direct oral anticoagulants, and anticonvulsants were administered. Nine months after initial hospitalization, the patient had a recurrence of acute ischemic stroke and was rehospitalized. He was treated with a new direct oral anticoagulant, clopidogrel, statins, and ethyl icosapentate. At 2 years after initial hospitalization, he has had no recurrence of stroke, has a modified Rankin Scale score of 2, and is currently being followed as an outpatient.

CONCLUSIONS:

A direct oral anticoagulant (edoxaban) and clopidogrel were effective for suspected recurrent acute ischemic stroke associated with dolichoectatic aneurysm of the ICA combined with contralateral dolichoectatic aneurysm, vertebrobasilar dolichoectasia, and atrial fibrillation.

• Authors: Yusuke Morinaga, Kouhei Nii, Kimiya Sakamoto, Ritsurou Inoue, Takafumi Mitsutake, Hayatsura Hanada
• Journal: World neurosurgery (World Neurosurg) Vol. 126 Pg. 146-150 (06 2019) ISSN: 1878-8769 [Electronic] United States
• PMID: 30858000 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Anticoagulants
• Platelet Aggregation Inhibitors
• Pyridines
• Thiazoles
• Clopidogrel
• edoxaban

Topics

• Aged, 80 and over
• Aneurysm (complications, diagnostic imaging, drug therapy)
• Anticoagulants (therapeutic use)
• Brain Ischemia (complications, diagnostic imaging, drug therapy)
• Carotid Artery Diseases (complications, diagnostic imaging, drug therapy)
• Carotid Artery, Internal (diagnostic imaging)
• Clopidogrel (therapeutic use)
• Humans
• Male
• Platelet Aggregation Inhibitors (therapeutic use)
• Pyridines (therapeutic use)
• Recurrence
• Stroke (complications, diagnostic imaging, drug therapy)
• Thiazoles (therapeutic use)
• Vertebrobasilar Insufficiency (complications, diagnostic imaging, drug therapy)