Ischemic stroke in young women associated with anomalies of the Willis circle and oral contraceptives

Abstract

Background. Taking into account the tendency to rejuvenate cerebrovascular pathology, it is important to study the etiopathogenesis of ischemic stroke (IS), especially at a young age, including women of the reproductive period. Objective. Analysis of etiopategenetic prerequisites and risk factors for the development of acute cerebrovascular accident (ACVA) in young people and presentation of a clinical case of patient with ACVA, pathogenic type - lacunar infarction in a young woman who took combined oral contraceptives (COCs) as a contraceptive during last 1 year. Methods. The authors analyzed the literature data and presented clinical laboratory data and the results of magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of cerebral vessels in a patient with a stroke. Results. The authors note that the clinic of ischemic stroke was confirmed by the data of MRI and MRA studies, which revealed in the left frontal lobe among old areas of encephalomalacia the presence of a new focus of lacunar infarction accompanied by disembryonic development of the circle of Willis, which was presented as hypoplasia of the left internal carotid artery (ICA) and left middle cerebral artery (MCA). Laboratory studies have shown a tendency towards thrombophilia. Conclusion. The authors discuss the role of vascular hypoplasia of the internal carotid artery system in the pathogenesis of acute cerebrovascular accidents in young women taking combined oral contraceptives for a long time. The presented case from practice showed that the hypercoagulable syndrome accompanied by COC intake and the small diameter of the ICA and MCA created favorable conditions for occlusion in the small perforating arteries of the deep structures of the brain and, thus, contributed to the development of a brain infarction on the side of the hypoplasia.