Teaching NeuroImages: Extracranial internal carotid artery aneurysm causing embolic stroke

A 42-year-old man with no history of trauma experienced acute numbness in his right arm and leg. A pulsating left cervical tumor was noted on clinical examination. Carotid ultrasound demonstrated significant widening of the left proximal internal carotid artery (ICA) and a large nonocclusive hypoechoic structure compatible with an aneurysm and intraluminal thrombus (figure, B, D, and E). MRI confirmed a fusiform extracranial ICA aneurysm and showed a left-sided small embolic stroke (figure, A and C). The patient underwent anticoagulation with low-molecular-weight heparin and eventually surgical treatment (i.e., resection and saphenous vein graft interposition). Histopathology revealed severe atherosclerosis. Extracranial ICA aneurysms are rare and can cause embolic stroke.1 The underlying etiology is diverse, with atherosclerosis being the most common entity.2

Source: Neurology - July 14, 2014 Category: Neurology Authors: Barlinn, K., Kepplinger, J., Puetz, V., Bodechtel, U. Tags: Stroke in young adults, MRI, Ultrasound, Embolism RESIDENT AND FELLOW SECTION Source Type: research