CERVICAL CAROTID-ARTERY VASOSPASMS CAUSING CEREBRAL-ISCHEMIA - DETECTION BY IMMEDIATE VASCULAR ULTRASONOGRAPHIC INVESTIGATION

Background-The etiology of cerebral ischemic accidents in young adults often remains unclarified. Case Description-A 32-year-old woman prese nted after multiple episodes of left monocular visual, impairment and right-sided focal signs. MRI revealed a low-flow infarction on the lef t; color-coded duplex sonography (CCDS), however, showed normal vascul ar findings. During the inpatient rehabilitation, a renewed visual imp airment occurred; an immediate CCDS examination now demonstrated a fil iform stenosis of the left internal carotid artery (ICA) 4 cm above th e origin and indirect signs of a severe stenosis of the right ICA. Res ults of a follow-up examination 18 hours later were again normal. Six weeks later, on reoccurrence of visual impairment, a reversible stenos is of the left ICA was again demonstrated. A search for possible cause s of vasospasm was unsuccessful. After treatment with calcium antagoni sts the patient was free of complaints (with the exception of 3 very s hort attacks of visual impairment) during the following 12 months. Con clusions-Cervical carotid artery vasospasms can apparently occur spont aneously without a mechanical trigger. Because their detection is diff icult, vasospasms may go undetected.