Lacunar Infarction and Carotid Artery Stenosis: A Case Report

Introduction: This report presents a case of a 56-year-old male patient diagnosed with both acute lacunar infarction and significant carotid artery stenosis, emphasizing the importance of a thorough vascular assessment in stroke patients.

Case Presentation: A 56-year-old male presented to the hospital with a one-day history of headache and unusual mental behavior. The patient reported forgetting to turn off the faucet and misidentifying zebra crossings. Physical examination revealed weakness and occasional numbness in his left hand.

Investigations: An MRI of the brain demonstrated an acute lacunar infarction in the right caudate nucleus. A routine carotid ultrasound revealed a slightly hypoechoic plaque at the bifurcation of the right common carotid artery and the origin of the internal carotid artery, causing stenosis of the proximal 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 measured approximately 81 cm/s. The PSVICA/PSVCCA ratio was 3.36, indicating a percentage diameter stenosis of approximately 58.4% according to the NASCET criteria.

Discussion: This case highlights the potential link between carotid artery stenosis and lacunar infarction. While the exact mechanism remains unclear, it is plausible that the stenosis contributed to reduced blood flow in the affected cerebral vessel, ultimately leading to the infarction.

Conclusion: This case underscores the importance of a comprehensive vascular evaluation in patients presenting with stroke symptoms, even when lacunar infarction is suspected. Early identification and management of carotid artery stenosis may help prevent future cerebrovascular events.

Lacunar Infarction and Carotid Artery Stenosis: A Case Report