Journal Of Cardiovascular, Neurovascular & Stroke

Recurrent Reversible Carotid Dissection in Antiphospholipid Syndrome: A Case Report and Systematic Review of Vasculopathic Mechanisms

Saima Ahmad — 2025-06-30

Antiphospholipid syndrome (APS) is increasingly recognized as a potential cause of cervical artery dissection, although the association remains underreported and poorly understood. We present a rare case of recurrent reversible internal carotid artery dissection in a patient with APS and systematically review current evidence regarding the pathophysiological mechanisms, clinical presentations, and management approaches. Our findings suggest that APS-related vasculopathy may predispose to arterial wall fragility and dissection through multiple mechanisms, including endothelial dysfunction, hypercoagulability, and altered vascular remodeling. Importantly, APS-associated dissections may demonstrate a higher potential for reversibility and recurrence compared to dissections of other etiologies, likely reflecting the dynamic nature of immune-mediated vascular injury rather than traditional atherosclerotic or traumatic causes. Recognizing this distinct entity is critical for appropriate management and prevention strategies in this population.

Acute Basilar Artery Occlusion: Treatment Challenges in a Complex Case with Concurrent Shingles and Post-COVID-19

Logadarshini Rajagopal — 2025-06-30

Introduction: Acute basilar artery occlusion is a neurological emergency and can lead to considerable neurological deficits up to complete tetraplegia, comatose states, and finally lethal outcomes if untreated. A decreased level of consciousness is most important in indicating BAO, requiring emergent treatment to restore blood flow and avert infarction. Therapy usually combines thrombolytics with mechanical thrombectomy for clearance of the occlusion.

Case Report: A 71-year-old gentleman, known to have had hypertension, woke up with an unsteady gait. His baseline brain scan had shown an infarct in the left cerebellum. He had been on DAPT. By the next day, his symptoms were progressing, including difficulty walking and slurred speech. Further investigations showed multiple acute infarcts in the midbrain, pons, and cerebellum. Treatment was complicated because he had recently recovered from COVID-19 and shingles. The patient underwent angioplasty; DAPT was continued. Although he started showing improvement, there were some remaining neurological deficits that required ongoing rehabilitation.

Conclusion: Coordinating the management of BAO in a patient with a complex medical history may require the input of multiple specialists. Ballooning as well as medical therapy are important in treatment, but decisions should be guided by the specifics of each case.

ABSENCE OF FLAIR HYPERINTENSE VESSEL SIGN IN INTERNAL CAROTID ARTERY OCCLUSION

Sin Yeat Mah — 2025-06-30

Large vessel occlusions (LVOs) are commonly associated with distinct pathognomonic radiological features, one of which is the fluid attenuation inversion recovery (FLAIR) hyperintense vessel sign (FHVS). This sign is indicative of an alteration in blood flow dynamics within the affected artery. In the majority of cases, the presence of arterial occlusion is accompanied by FHVS. However, there are exceptions wherein FHVS is absent despite the presence of an occlusion. This case report presents a patient with a complete right internal carotid artery (ICA) occlusion who exhibited relatively mild clinical deficits and limited infarction volume, alongside a notable absence of FHVS. This finding offers an opportunity to explore the pathophysiological mechanisms that might explain the absence of FHVS in such cases and its potential relationship with collateral circulation. The case report is followed by a systematic literature review that supports the phenomenon, that is, the absence of FHVS in cases of internal carotid artery occlusion.