Lacunar Infarction and Carotid Stenosis in a 56-Year-Old Male: A Case Report

Lacunar Infarction and Carotid Stenosis in a 56-Year-Old Male: A Case Report

Introduction: This case report presents a 56-year-old male patient who presented with neurological symptoms and was diagnosed with both acute lacunar infarction and significant carotid artery stenosis.

Case Presentation: A 56-year-old man was admitted to the hospital with a one-day history of headache and abnormal mental behavior. He reported forgetfulness, such as leaving the faucet running, and confusion about zebra crossings. Physical examination revealed weakness in his left hand, accompanied by occasional numbness.

Investigations: An MRI examination of the brain revealed an acute lacunar infarction in the right caudate nucleus. A routine carotid ultrasound examination showed a slightly hypoechoic plaque at the bifurcation of the right common carotid artery and the beginning of the internal carotid artery, causing stenosis of the initial segment of the internal carotid artery. The maximum flow velocity at the stenosis was approximately 272 cm/s, while the flow velocity near the proximal end of the stenosis was about 81 cm/s. The peak systolic velocity ratio (PSVICA/PSVCCA) was 3.36, and based on the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, the percentage diameter stenosis was approximately 58.4%.

Discussion: This case highlights the importance of considering carotid artery stenosis in patients presenting with neurological symptoms, even in the presence of lacunar infarction. The significant stenosis identified in this patient likely contributed to the development of his lacunar stroke. Further investigation and management of the carotid stenosis are crucial to minimize the risk of future cerebrovascular events.

Conclusion: This case emphasizes the need for a comprehensive approach to evaluating neurological symptoms and underscores the importance of early detection and management of carotid artery disease.