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Case Reports
. 2021 Jun 27;13(6):e15971.
doi: 10.7759/cureus.15971. eCollection 2021 Jun.

Bilateral Internal Carotid Artery Occlusion, an Unusual Clinical Entity in a Young Adult

Monika Karki  1 , Pradeep Kumar Devarakonda  1 , Lohitha Dhulipalla  1 , Meghana Pattipati  1 , Cesar Ayala-Rodriguez  2
Affiliations
Case Reports

Bilateral Internal Carotid Artery Occlusion, an Unusual Clinical Entity in a Young Adult

Monika Karki et al. Cureus. .

Abstract

Bilateral internal carotid artery occlusion (BICAO) is a rare disease leading to serious cerebrovascular disease and complications including recurrent ischemic stroke or death. There are very few cases reported on BICAO, especially among young adults. The clinical presentation can range from asymptomatic to fatal ischemic stroke depending upon the presence of adequate collateral blood flow. Here we report a case of BICAO in a 31-year-old female who presented with intermittent left-sided hemiparesis for one day and was subsequently found to have complete occlusion of the bilateral intracranial internal carotid arteries on CT angiography (CTA). Magnetic resonance imaging (MRI) brain showed sub-acute right middle cerebral artery (MCA), acute left middle cerebral artery, and anterior cerebral artery infarcts (ACA). Being outside the window for thrombolysis, she was successfully treated with balloon angioplasty of the left internal carotid artery (ICA) and started on dual antiplatelet therapy. The case illustrates the importance of evaluating for cerebrovascular disease when someone presents with stroke-like symptoms even in the young adult population, as prompt treatment can be lifesaving.

Keywords: : ischemic stroke; bilateral internal carotid artery stenosis; carotid endarterectomy (cea); hypoesthesia; internal carotid artery (ica).

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. A sagittal image of CTA head and neck, arrow showing stenosis in proximal ICA
CTA: CT angiography; ICA: Internal carotid artery.
Figure 2
Figure 2. Axial image, stenosis is shown with arrow
Figure 3
Figure 3. Coronal image, stenosis is shown with arrow
Figure 4
Figure 4. Cerebral angiogram, stenosis of left ICA at multiple level shown with arrow
ICA: Internal carotid artery
Figure 5
Figure 5. Cerebral angiogram, right MCA (curved arrow in left picture) supplied retrogradely via PComm (small arrow in right picture)
MCA: Middle cerebral artery; PComm: Posterior communicating arteries.
See this image and copyright information in PMC

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