Ann Clin Neurophysiol.  2017 Jan;19(1):46-49. 10.14253/acn.2017.19.1.46.

Carotidynia presenting with acute ischemic stroke after carotid sinus massage

• Kwak HS
• Chung GH
• Lee CH
• Jeong SK
• Ryu HU

• KMID: 2367994
• DOI: http://doi.org/10.14253/acn.2017.19.1.46

Abstract

Carotidynia is characterized by unilateral neck pain around the carotid artery. We describe a 50-year-old woman who presented with transient left-side weakness and right-side neck pain. She frequently massaged the uncomfortable neck area during the symptomatic course of the condition. Magnetic resonance imaging revealed multifocal cerebral infarctions and a carotid intramural thrombus ipsilateral to the carotidynia.Long-term carotidynia might result in the involvement of an intramural thrombus and intimal disruption, and ischemic stroke after carotidynia may be provoked by carotid sinus massage.

Keyword

Carotid artery; Pain; Massage

MeSH Terms

Carotid Arteries
Carotid Sinus*
Cerebral Infarction
Female
Humans
Magnetic Resonance Imaging
Massage*
Middle Aged
Neck
Neck Pain
Stroke*
Thrombosis

Figure

• 

  Fig. 1. A 50-year-old woman with a transient left-side weakness and mild dysarthria. (A) Diffusion-weighted imaging showing multifocal infarctions in the right basal ganglia, frontal cortex, and parietal cortex. (B) Volume-rendering imaging showing a filling defect in the long segment of the CCA and ICA (arrows). (C) Axial source image of time-of-flight carotid MRA showing a massive intraluminal filling defect in the right CCA (arrow). (D) Axial image of nonenhanced T1-weighted carotid MRI showing the intravascular thrombus without an intramural plaque or intimal flap (arrow). (E) Axial image of nonenhanced T2-weighted carotid MRI showing the intravascular thrombus without an intramural plaque or intimal flap (arrow). (F) Contrast-en-hanced MRI of the right CCA showing the circumferential enhancement (arrowheads) with a mural wall thrombus (arrows). (G) Contrast-enhanced MRI of the right ICA showing the intimal disruption (arrow). (H) Contrast-enhanced axial imaging performed 10 days after the initial carotid plaque MRI showing complete resolution of the mural wall thrombus and intimal disruption and a marked decrease in the circumferential carotid wall enhancement. CCA, common carotid artery; ICA, internal carotid artery; MRA, magnetic resonance angiography; MRI, magnetic resonance imaging.

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