Carotid web and ischemic stroke in young adult: a case report
Notice bibliographique
Résumé
SLNL, 44 years old, female, massage therapy professional, married, admitted to the neurological emergency department of a tertiary hospital with a history of right-sided hemiparesis, aphasia and combined gaze deviation to the left with a sudden onset lasting 3 hours and 30 minutes. On admission, she underwent a head tomography (CT) scan without acute injuries, with an Alberta Stroke Program Early CT Score (ASPECTS) of 10 points. In the absence of contraindications, as well as within the therapeutic window, chemical thrombolysis was performed with alteplase, with slight gingival bleeding. The patient had an initial NIHSS of 20 points, with a final NIHSS of 9 points, showing partial improvement in strength deficit and aphasia. The patient remained in the stroke unit and underwent control neuroimaging the following day, showing hypodensity in the territory of the left middle cerebral artery. The patient was discharged from the stroke unit for follow-up in the neurology ward, where the etiological investigation continued. Hypertensive patient with recent diagnosis, dyslipidemic, overweight and without other comorbidities. She evolved with significant improvement, presenting some phonemic and semantic paraphasias during hospitalization. During the etiological investigation, she underwent magnetic resonance imaging of the brain that showed diffusion restriction with hypersignal on T2/FLAIR affecting the cingulate gyrus, precuneus, insula and left frontoparietal opercular region without post-contrast enhancement, compatible with recent ischemia. Remaining unchanged. Usg doppler of carotid and vertebral arteries without changes. However, resonance angiography of intracranial vessels showed irregularities in the posterior wall of the origin of the left internal carotid artery, insinuating itself into the lumen, compatible with the same side of the ischemiated territory; suggesting carotid membrane or carotid web. Patient was released home and returned for elective angioplasty with carotid stent to treat carotid web. She was again discharged from hospital with a final NIHSS of 3 points, using dual antiplatelet therapy with acetylsalicylic acid (ASA) and clopidogrel, in addition to a high-potency statin. Carotid web is a rare event, often undiagnosed, representing a risk of recurrence for stroke in the absence of other risk factors. The webs are protrusions into the lumen of the vessel, similar to a shelf, and can be considered a variant of fibromuscular dysplasia. Regarding treatment, there are favorable clinical results with both angioplasty and endartectomy, although there are few reports describing angioplasty with stent. For this reason, there must be a high clinical suspicion in young patients, without defined causes, in cases of cryptogenic stroke, for timely diagnosis and prevention of recurrences and future disabilities.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».