Transcranial Color-coded Sonography to assess Collateral Posterior Pathways in a case of spontaneous Bilateral Carotid Arteries Dissection in the Absence of Ischaemic Event

Introduction

Stroke is the most common brain disease. Spontaneous cervical artery dissection (sCAD) is a relative rare cause of stroke overall, but is an important cause among young adults. Otherwise sCAD may sometimes affect several vessels (Hassan AE et al. J Stroke Cerebrovasc Dis 2013; 22: 42–48).

Conventional angiography has long been the gold standard in the diagnosis of sCAD but has been replacing recently by magnetic resonance imaging (MRI) and MR angiography (MRA) as well as computed tomography (CT). In any case, only ultrasound techniques enable visualization and measurement of flow dynamics in a vessel.

Transcranial color-coded sonography (TCCS) is a radiation-free, non-invasive screening method to explore intracranial arteries. Moreover, TCCS is easy to implement at the patient's bedside and can be repeated as often as required like an arterial monitoring system especially in stroke units. Although TCCS has proved effective in assessing the collateral function of the circle of Willis in healthy volonteers (Hoksbergen AW et al. Am J Neuroradiol 2003; 24: 456–462), its use in clinical practice is relatively sparse especially in neurologic teams.

We report the case of a young woman with sCAD of both extra-cranial internal carotids presenting with pain as the only symptom (Arnold M et al. J Neurol Neurosurg Psychiatry 2006; 77: 1021–1024). TCCS was of real clinical interest to confirm the presence and direction of collateral flows in posterior communicating arteries (PcoA).