Article

Idiopathic vasospastic angiopathy of the internal carotid arteries
is a rare and largely unknown cause of ischemic stroke. METHODS: We report the
case of a 39-year-old man with migraine treated by beta-blockers, who had been
suffering from progressive right visual impairment and headache for one week. He
then experienced a seizure and left hemiparesis. Ophthalmological examination
revealed right retinal ischemia and partial left homonymous hemianopia. MRI
revealed a long stenosis of both carotid arteries and a recent ischemic stroke in
the territory of the right middle cerebral artery. The diagnosis of vasospastic
angiopathy of the internal carotid arteries was made based on a second MRI and
colored duplex sonography which showed a decrease in the stenosis and no
intraparietal hematoma confirming the vasospasm mechanism for stenosis. The
clinical course was favorable with calcium channel blockers and aspirin. Use of
vasoconstrictor treatments was contraindicated. DISCUSSION/CONCLUSION: Idiopathic
vasospastic angiopathy of the internal carotid arteries has been rarely
documented. Association with migraine has been mentioned but remains unclear in
the literature. This etiology for stroke is probably under-diagnosed due to lack
of rapid and repeated examinations of the cervical arteries (angio-MR and colored
duplex sonography) to confirm the vasospasm mechanism. Recurrences have been
reported justifying a specific secondary preventive treatment to induce
vasodilatation. Vasoconstrictor treatments should be contraindicated.
CI - Copyright (c) 2011 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS