Proximale fibromuskuläre Dysplasie der Arteria carotis interna als seltene Ursache von rezidivierenden Schlaganfällen

Zusammenfassung

Die fibromuskuläre Dysplasie der proximalen A. carotis interna ist eine seltene und unterdiagnostizierte Ursache von Schlaganfällen. Angiografisch hat sie die Form eines Septums bzw. einer Membran. Als Schlaganfallmechanismus wird eine Flussturbulenz und Blutstase distal des Septums mit konsekutiver Thrombusbildung angenommen. Die Thrombozytenaggregantionshemmung zur Schlaganfallprävention ist in dem Fall wenig wirksam. Wir berichten über einen jungen Erwachsenen mit der Diagnose einer proximalen fibromuskulären Dysplasie der rechten A. carotis interna. Der Patient erlitt über Jahre rezidivierende thromboembolische Hirninfarkte im gleichen Gefäßterritorium. Die Schlaganfälle wurden zunächst als kryptogen gedeutet. Unser Fall zeigt, dass bei unklaren rezidivierenden Schlaganfällen im gleichen Gefäßterritorium an die seltene Ursache einer proximalen fibromuskulären Dysplasie gedacht werden sollte.

Abstract

Fibromuscular dysplasia of the proximal internal carotid artery is a rare and underestimated cause of stroke. At angiography it has the appearance of a septum or a membrane. The stroke mechanism is deemed to result from turbulent blood flow and stasis upstream to the membrane, which leads to thrombus formation. The antiplatelet therapy has thereby little effect on stroke prevention. We present the case of an young adult with the diagnosis of proximal fibromuscular dysplasia of the right internal carotid artery. He has suffered from recurrent thromboembolic strokes in the same vascular territory for years. Initially, the diagnosis of cryptogenic strokes was made. Proximal fibromuscular dysplasia, though rare, should be considered in patients with recurrent strokes in the same vascular territory.

Schlüsselwörter

fibromuskuläre Dysplasie - Carotisseptum - kryptogener Schlaganfall - rezidivierender Schlaganfall

Keywords

fibromuscular dysplasia - carotid web - cryptogenic stroke - recurrent stroke

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