Circuitous embolic hemorrhagic stroke: carotid pseudoaneurysm to fetal posterior cerebral artery conduit: a case report
Circuitous embolic hemorrhagic stroke: carotid pseudoaneurysm to fetal posterior cerebral artery conduit: a case report
Abstract
Introduction
The cervical internal carotid artery (ICA) is susceptible to injury through various mechanisms, including dissection, which can lead to pseudoaneurysm formation. Pathological processes affecting the ICA, in association with an ipsilateral fetal posterior cerebral artery (PCA), resulting in parieto-occipital strokes are rarely reported.
Case Presentation
We present a patient with a left PCA territory, presumably embolic, stroke with early hemorrhagic transformation. The identified nidus of the embolus was a carotid artery pseudoaneurysm. Manifestations included right homonymous hemianopsia with right hemiparesis and hemisensory loss.
Conclusion
Our case is unique, and of clinical interest, because it illustrates both the potential anterior-posterior circulation conduit provided by a fetal origin PCA as well as the apparent early hemorrhagic transformation of embolic infarcts that can lead to further confusion from a mechanistic standpoint.
Introduction
Unexplained hemorrhagic stroke is not infrequently encountered. There are a number of possible mechanisms for such a presentation and it is important to determine the pathogenesis as accurately as possible in an effort to prevent recurrence. Vascular dissection represents tearing of the vessel between the adventia and the intima or the intima and the media. Clinical presentation is usually related to hematoma formation which can compromise the vessel lumen and lead to cerebral infarction as the most common clinical presentation [1]. An alternative mechanism of stroke is aneurysmal outpouching of the affected vessel, resulting in what is termed a pseudoaneurysm, and this can be associated with thrombus formation with the potential for thrombo-embolism into the more distal circulation [2]. Fibromuscular dysplasia (FMD) can contribute to predisposition to vascular dissection [3,4].
Circuitous embolic hemorrhagic stroke, hemorrhagic stroke, carotid pseudoaneurysm, cerebral artery conduit, vascular surgery, digital subtraction angiography, common carotid artery, internal carotid artery, haemorrhagic trasformation stroke, hypertension harmorrhagic stroke, intracranial haemorrhage stroke, cerebral hamorrhage stroke,
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