Abstract
A 52 year old man without vascular risk factors, presented with sudden onset of left sided weakness. Brain magnetic resonance imaging showed a striatocapsular infarct. (A) Duplex ultrasonography revealed a hyperechogenic septum along the right carotid bulb associated with thrombus (arrow), without significant stenosis (< 50% North American Symptomatic Carotid Endarterectomy Trial [NASCET]). Volume rendered computed tomography angiography identified carotid web. Carotid endarterectomy was performed with subsequent histology (B) showing non-atheromatous intimal fibrous thickening and adherent thrombus. No recurrent stroke occurred during follow up. Carotid web diagnosis is challenging and supportive histology might be needed. This under recognised cause of stroke is not typically associated with significant stenosis and may appear similar to atherosclerotic plaque.Image 1
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