A rare case report of bilateral internal carotid artery hypoplasia in postpartum female: Clinical spectrum and role of various modalities in diagnosis

Abstract

Congenital hypoplasia of bilateral internal carotid arteries (ICAs) is an extremely rare anomaly with less than 25 reported cases in literature till date. We present a case of a 30-year-old primigravida, who developed seizures and subsequently loss of consciousness just few minutes after the delivery of a healthy male child. To the best of our knowledge, this is the first case with bilateral ICA hypoplasia presenting in postpartum female who developed infarct in bilateral frontal region and subarachnoid hemorrhage (SAH). On a postpartum three-dimensional (3D) computed tomography (CT) angiography, bilateral ICA hypoplasia was confirmed and the manifestations of infarcts were probably the consequence of altered hemodynamics of pregnancy. In conclusion, a patient in her late pregnancy and postpartum period, having nonspecific cerebral symptoms or having suffered a cerebrovascular accident, should not only be evaluated for pregnancy or puerperium-related complications but also whenever possible a baseline screening with Doppler study of neck vessels and a noncontrast magnetic resonance imaging (MRI) angiography of neck and cerebral vessels should be performed to rule out congenital anomalies.

Congenital internal carotid artery hypoplasia: A systematic review

“…One record reported the canal diameter as 2.5 mm on the right and 2.8 mm on the left. 28 A normal carotid canal diameter is 5.27 mm (SD +/−0.62) according to a recent study. 34 Ten cases did not state whether the carotid canal was investigated, and one reported a carotid canal with a normal diameter.…”

“…Stroke-related symptoms were the most frequent reasons for an encounter with a physician (14 of 36 reports). Presentations included vision loss, 38,29,39 hemiplegia, 8,28,40,41,42 dysarthria 8,35,43,44 and TIA. 33,36 Vision loss, specifically amaurosis fugax due to ophthalmic artery insufficiency was found in two cases.…”

“…Other frequent presenting complaints were headache (six reports), 3,15,29,44,59,62 and seizure (four reports). 28,30,63,64 SAH (subarachnoid haemorrhage) due to a ruptured aneurysm was the cause of these symptoms in four reports. 3,28,63,64…”

“…3,9,22,33,60,62 In the unilateral cases, the enlarged PComA was ipsilateral to the hypoplastic ICA. 28,29,32,44,61,65 Other patterns of collateral circulation were via an enlarged vertebrobasilar system (3 reports), or via the contralateral ICA and enlarged ACA (3 reports). Three reports identified persistent primitive vessels.…”

The cerebral circulation and cerebrovascular disease I: Anatomy

“…On the left side of the body, however, there is no brachiocephalic trunk: on this side, the common carotid artery comes directly from the aortic arch as its second branch. [ 7 ] Despite this variation in origin, the common carotid arteries then pursue a symmetrical ascent in the chest, ending as they split into the internal and external carotid arteries at the superior border of the thyroid cartilage, at around the level of fourth cervical vertebra. [ 2 ] Unlike the external carotid arteries, the internal carotid arteries do not give off any branches in the neck.…”