acyclovir and Carotid-Stenosis

Background and Purpose- Focal cerebral arteriopathy is monophasic inflammatory stenosis of the distal internal carotid artery or the proximal segment of the middle cerebral artery. It is one of the most common causes of acute arterial ischemic stroke in young children but is a less familiar entity for adult neurologists. Methods- We retrospectively reviewed stroke service radiology records at a tertiary referral center from January 2013 to December 2014. Focal cerebral arteriopathy was defined as nonprogressive unifocal and unilateral stenosis/irregularity of the distal internal carotid artery or its proximal branches. Only patients aged 16 to 55 years with stroke were included. Results- There were 5 cases of focal cerebral arteriopathy: 2 males and 3 females. Three cases were from the cohort of 123 acute presentations of young stroke, and 2 cases were outpatient referrals. The mean age (range) was 43 (32-55) years. The majority presented with recurrent transient ischemic attacks/minor strokes within a single vascular territory over days to weeks. All cases had characteristic radiological features. Interval imaging demonstrated resolution in 1 case and improvement in 3 cases. Functional outcome was excellent with discharge modified Rankin Scale score ranging from 0 to 1. Recurrence occurred in 1 case. Conclusions- Focal cerebral arteriopathy is a rare cause of arterial ischemic stroke in young adults. Follow-up intracranial imaging is essential to differentiate from progressive arteriopathies. Evidence-based treatment warrants further investigation. Prognosis is favorable.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Aspirin; Carotid Artery, Internal; Carotid Stenosis; Cerebral Angiography; Cerebral Arterial Diseases; Computed Tomography Angiography; Dual Anti-Platelet Therapy; Female; Glucocorticoids; Herpesvirus 3, Human; Humans; Immunoglobulin G; Immunoglobulin M; Ischemic Attack, Transient; Male; Middle Aged; Middle Cerebral Artery; Platelet Aggregation Inhibitors; Recurrence; Retrospective Studies; Stroke