Left internal carotid artery agenesis in a patient with headache

Inês Alice Teixeira Leão,C H Rezende,J B L Gomes,R F Almeida

doi:10.48208/headachemed.2014.5

Inês Alice Teixeira Leão, C H Rezende + Show 2 more

Open Access

https://doi.org/10.48208/headachemed.2014.5

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Journal: Headache Medicine	Publication Date: Mar 31, 2014
License type: CC BY 4.0

Affiliation: Military Hospital

Abstract

Sometimes in clinical neurology, we diagnose a very rare case. We report on a patient who presented with crisis of headache and vomiting (clinically diagnose as migraine). Computed tomography (CT) scan of the head did not reveal any structural lesion. Magnetic resonance angiography showed absence of left internal carotid artery associated with absence of the left middle cerebral artery (MCA).

Highlights

INTRODUCTIONAgenesis of internal carotid artery (ICA) is a rare congenital anomalywith an incidence of 0.01%.(1,2) Most of the patients are asymptomatic and is usually discovered incidentally by computed tomography (CT) or magnetic resonance imaging (MRI)
Agenesis of internal carotid artery (ICA) is a rare congenital anomalywith an incidence of 0.01%.(1,2) Most of the patients are asymptomatic and is usually discovered incidentally by computed tomography (CT) or magnetic resonance imaging (MRI).Headache Medicine, v.5, n.1, p. 25-27, Jan./Feb./Mar. 2014In 1954, Tode et al[3]described the first case of this condition and, in 1954, Verbiest et al[4]demonstrated the absence of the ICA by angiography for the first time.The most common source of collateral circulation in the case of the ICA agenesis is via the circle of Willis.[5]
In these cases, the basilar artery or the contralateral ICA supplies the middle cerebral artery (MCA) and anterior cerebral artery (ACA) on the side of the absent ICA.[5]

Summary

INTRODUCTION

Agenesis of internal carotid artery (ICA) is a rare congenital anomalywith an incidence of 0.01%.(1,2) Most of the patients are asymptomatic and is usually discovered incidentally by computed tomography (CT) or magnetic resonance imaging (MRI). A 33-year-old woman, presented to our Headache Ambulatory with a history of chronic headache since 1999 She described pulsatile, right headache,of moderate to strong intensity, worsened by physical activities, associated to nausea, vomiting, photophobia, phonophobia and osmophobia, 1 to 2 crises (episodes) per month. Her pain was refractory to various pain-killers and non-steroidal anti-inflammatory drugs, such as naproxen; cefalium®; naratriptan; sumatriptan; ibuprofen and ergotamine She used many preventive medicines against migraine, with partial results, e.g. fluoxetina; bupropion; venlafaxine; alprazolam; clonazepan; atenolol and cyclobenzaprine. Angio RM (magnetic resonance angiograph) of the brain and of the carotid and vertebral arteries in 3.September.2013 showed left ICA agenesis (Figures 1 and 2). Nowadays she is taking mirtazapine (30mg/day), sumatriptain and ketorolac with good response

DISCUSSION

CONCLUSIONS