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Case Reports
. 2024 Jul 5;86(9):5523-5528.
doi: 10.1097/MS9.0000000000002346. eCollection 2024 Sep.

Life-threatening bilateral internal carotid artery and unilateral vertebral artery total occlusion presenting with dizziness: a case report

Affiliations
Case Reports

Life-threatening bilateral internal carotid artery and unilateral vertebral artery total occlusion presenting with dizziness: a case report

Afnan W M Jobran et al. Ann Med Surg (Lond). .

Abstract

Introduction: It is well known that whereas bilateral occlusion is less common, unilateral internal carotid artery blockage happens regularly. Asymptomatic to fatal ischemic stroke can be the clinical presentation, depending on whether there is adequate collateral blood flow. Internal carotid artery occlusion is often associated with significant neurologic events, both at the time of initial occlusion and during follow-up.

Case presentation: The authors describe a patient's experience of dizziness followed by a fall. The hyperdense position of the basilar artery near its bifurcation was identified following a computed tomography (CT) scan. Furthermore, the pons, midbrain, and medial parts of the right temporal lobe showed numerous small hypodensities suggestive of an ischemic injury. The patient had medical treatment without surgery after it was determined that they had bilateral internal carotid arteries and a blocked right vertebral artery. After taking dual anti-platelet therapy for 5 days, the patient recovered without incident and was discharged from the hospital.

Discussion: In a young patient with bilateral internal carotid arteries occlusion (BICAO), the authors highlighted the significance of prompt diagnosis of stroke-like symptoms, diagnostic possibilities, and treatment options. Options for diagnosis include brain MRI and CT head to check for ischemia and CT angiography (CTA) head and neck to assess for artery obstruction. Options for treatment include severe medical and surgical treatments, such as carotid endarterectomy, stent implantation, or balloon angioplasty, or medical management alone, such as dual anti-platelet medication and thrombolysis.

Conclusion: BICAO is associated with a grave prognosis and significant cerebrovascular complications. High-quality studies are needed to establish the best treatment strategy, considering the complex and individualized nature of the condition.

Keywords: bilateral internal carotid arteries; case report; dizziness; stroke; unilateral; vertebral artery occlusion.

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Conflict of interest statement

There is no conflict of interest to declare.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Axial brain computed tomography scan show: hyperdense basilar artery (black arrow) and focus of hypodensity (blue arrow).
Figure 2
Figure 2
DWI (left) and ADC (right) sequences of brain MRI show small areas of restriction diffusion. ADC, apparent diffusion coefficient; DWI, Diffusion‐weighted imaging.
Figure 3
Figure 3
Axial and sagittal views of neck computed tomography angiography show occlusion in both internal carotid arteries (ICAs).
Figure 4
Figure 4
Axial and coronal views of neck computed tomography angiography show complete occlusion in right vertebral artery.

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