An Ischemic Stroke in a Sub-Saharan African Patient Revealing a Carotid Web: A Case Report and a Systematic Literature Review

Abstract

One third of ischemic strokes have no known cause, and basic understanding of the mechanisms of these “cryptogenic” strokes is lacking. However, observational studies are increasingly bringing to light an etiology that has long remained hidden, the carotid web. The authors report a case of carotid web in a 32-year-old patient, gardener, from sub-Sharan Africa, with no medical history or known cerebrovascular risk factors. Indeed, due to a sudden weakness of his left limbs, the MRI was performed and revealed an ischemic stroke positive on diffusion-weighted within the territory of the right middle cerebral artery. FLAIR sequences were normal, while T2* sequences revealed an M1 thrombus ipsilateral to the brain lesion. After thrombolysis and thrombectomy, the patient’s weakness improved significantly. Digital subtraction angiography of supra-aortic trunks revealed the carotid web, which was incriminated as the etiology of this ischemic stroke in the absence of any abnormality on the other ancillary examinations that were performed. To prevent a recurrence, the patient was given Aspegic 250 mg/day and received physical therapy. The clinical course was improved and at 3 months, there was no new cerebrovascular event and his Rankin score was 1.