Carotid web and ischemic stroke in young adult: a case report
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".