Dissecazione carotidea bilaterale spontanea che si presenta con un’amnesia transitoria: una presentazione inusuale di un evento raro
Spontaneous bilateral carotid artery dissection presenting as transient amnesia: a case report
A 47-year-old workman shows up for work on the day the factory is closed and is found causally after a few hours disoriented and confused by the employer.
After a first evaluation by EMS, the temporal disorientation, confusion is confirmed and the patient does not remember what happened up to that moment. The vital signs detected are normal and no facial palsy are detected.
During transport to the emergency room of the hub hospital the conditions worsen, the patient becomes dysphasic, is not able to perform simple orders and appears deviated labial rhyme.
Afterwards the angio-CT scan detects right ICA occluded in the intra and extra cranial section and the cervical tract of left ICA shows a threadlike appearance in extracranial section.
An MRI with contrast medium is also performed and a neurosurgical consultation is required which confirms the bilateral dissection of the carotid arteries.
The patient is transferred to the neurosurgery and four days later stents are applied to the left ICA, an operation that is not possible on the right ICA due to the presence of false lumen.
Start drug therapy with antiplatelet Duoplavin: 1 tablet per day.
After 10 days the patient during a neurological check-up reports a slight improvement in headache, is cooperative and oriented, does not present any motor or sensory deficit.
The neurologist recommends continuing with drug therapy and hydrating abundantly.
Given the rarity of bilateral spontaneous carotid dissection, a genetic pathology affecting the vessel wall may be suspected.
The most interesting points of this case, according to our point of view, are the curious way in which a spontaneous bilateral ICA dissection was manifested: with a transient amnesia, in the absence of any other stroke symptom, and the spontaneous bilateral ICA dissection in a young patient and in the absence of significant risk factors.
Keywords: Spontaneous bilateral carotid artery dissection, transient amnesia, temporal disorientation.
P. Parogni, Responsabile AAT Mantova - AREU Lombardia – Mantova
C. Sozzi, Dirigente Medico, Diagnostica per immagini – ASST “C. Poma” – Mantova
M. Sarzi Amadè, Inferimere, AAT Mantova - AREU Lombardia – Mantova