Kumagawa Takahiro, Negishi Hiroshi, Yamamuro Shun, Shijo Katsunori, Yoshino Atsuo
Neurological Surgery, Nihon University School of Medicine, Tokyo, JPN.
Cureus. 2025 Aug 19;17(8):e90525. doi: 10.7759/cureus.90525. eCollection 2025 Aug.
Recurrent ischemic stroke with no clearly identified embolic source poses a significant diagnostic challenge. We report the case of a 73-year-old woman who experienced four episodes of cerebral infarction, all localized to the right middle cerebral artery territory. According to medical records from the referring hospital, the first three strokes occurred over three years. They were diagnosed as having an embolic stroke of undetermined source after extensive evaluation failed to identify a definitive cause. Although carotid ultrasonography and magnetic resonance angiography had revealed a right common carotid artery aneurysm during earlier evaluations, the absence of thrombus led clinicians to exclude it as an embolic source. At the time of the fourth stroke, follow-up carotid ultrasound demonstrated turbulent flow and bright, mobile intraluminal structures within the aneurysm, strongly suggesting thrombus formation. The patient subsequently underwent successful endovascular treatment with stent placement and coil embolization. No recurrence of stroke has been observed during the five-year follow-up. This case highlights that extracranial carotid artery aneurysms, although rare, should be considered as potential embolic sources, particularly when intra-aneurysmal thrombus is suspected. Endovascular intervention may be an effective strategy to prevent recurrent embolic stroke in such patients.
复发性缺血性卒中且栓子来源不明给诊断带来了重大挑战。我们报告了一例73岁女性患者的病例，该患者经历了四次脑梗死发作，均局限于右侧大脑中动脉供血区。根据转诊医院的病历记录，前三次卒中发生在三年时间内。在经过广泛评估未能确定明确病因后，它们被诊断为不明来源的栓塞性卒中。尽管在早期评估中颈动脉超声和磁共振血管造影显示右侧颈总动脉有一个动脉瘤，但由于没有血栓，临床医生将其排除为栓子来源。在第四次卒中时，随访的颈动脉超声显示动脉瘤内血流紊乱，管腔内有明亮的、可移动的结构，强烈提示血栓形成。该患者随后成功接受了支架置入和弹簧圈栓塞的血管内治疗。在五年的随访中未观察到卒中复发。该病例强调，尽管颅外颈动脉动脉瘤罕见，但应将其视为潜在的栓子来源，尤其是当怀疑动脉瘤内有血栓时。血管内介入治疗可能是预防此类患者复发性栓塞性卒中的有效策略。
