RESUMEN
Carotid artery web is considered an exceptional cause of recurrent ischemic strokes in the affected arterial territory. The underlying pathology proposed for this entity is an atypical fibromuscular dysplasia. We present the case of a 43-year-old woman with no cardiovascular risk factors who had experienced 2 cryptogenic ischemic strokes in the same arterial territory within an 11-month period. Although all diagnostic tests initially yielded normal results, detailed analysis of the computed tomography angiography images revealed a carotid web; catheter angiography subsequently confirmed the diagnosis. Carotid surgery was performed, since which time the patient has remained completely asymptomatic. The histological finding of intimal hyperplasia is consistent with previously reported cases of carotid artery web. Carotid artery web is an infrequent cause of stroke, and this diagnosis requires a high level of suspicion plus a detailed analysis of vascular imaging studies.
Asunto(s)
Isquemia Encefálica/etiología , Enfermedades de las Arterias Carótidas/complicaciones , Arteria Carótida Interna/patología , Displasia Fibromuscular/complicaciones , Accidente Cerebrovascular/etiología , Adulto , Aspirina/uso terapéutico , Atorvastatina/uso terapéutico , Biopsia , Isquemia Encefálica/diagnóstico por imagen , Fármacos Cardiovasculares/uso terapéutico , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/tratamiento farmacológico , Enfermedades de las Arterias Carótidas/patología , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/efectos de los fármacos , Angiografía por Tomografía Computarizada , Femenino , Displasia Fibromuscular/diagnóstico por imagen , Displasia Fibromuscular/tratamiento farmacológico , Displasia Fibromuscular/patología , Humanos , Hiperplasia , Neointima , Recurrencia , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico por imagenRESUMEN
Opercular myoclonic-anarthric status epilepticus (OMASE) is a rare form of epilepsia partialis continua presenting as fluctuating dysarthria, or even anarthria. The condition is caused by an epileptogenic lesion involving the opercular cortex of either hemisphere. Speech impairment is secondary to bilateral epileptic activity affecting the glossopharyngeal muscles. This bilateral nature of the condition is due to the fact that innervation of cranial nerves V, VII, IX, X and XII from the opercular area of the primary motor cortex is bilateral. The aetiology of the condition varies, and includes vascular lesions, tumours, and encephalitis, among other causes. A low threshold for clinical suspicion is necessary in order to ensure the timely initiation of antiepileptic treatment, thereby preventing the condition from becoming drug resistant. We present two cases of OMASE which differ in terms of aetiology, clinical course, and treatment response. [Published with video sequences on www.epilepticdisorders.com].
Asunto(s)
Encéfalo/fisiopatología , Disartria/diagnóstico , Estado Epiléptico/diagnóstico , Anciano , Anticonvulsivantes/uso terapéutico , Encéfalo/diagnóstico por imagen , Disartria/tratamiento farmacológico , Disartria/fisiopatología , Electroencefalografía , Humanos , Masculino , Estado Epiléptico/tratamiento farmacológico , Estado Epiléptico/fisiopatología , Resultado del TratamientoRESUMEN
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