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Recurring episodes of temporary hemiparesis in young adults are often regarded as ischaemic or migrainous attacks, although non-vascular pathogenesis such as multiple sclerosis should not be ruled out. Vasospasm is known to accompany migraine, but spontaneous vasospasm as a cause of temporary hemiparesis has been rarely demonstrated except in those cases induced by subarachnoid haemorrhage and those induced by mechanical manipulations.
We report a case of repeated internal carotid artery (ICA) vasospasm. Magnetic resonance angiography (MRA), colour coded duplex sonography (CCDS), and [99mTc]-hexamethylpropyleneamine oxime single photon emission computed tomography (HMPAO-SPECT) together were successful in demonstrating the ICA vasospasm and resulting cerebral ischaemia.
A 35 year old right handed man presented at our department for repeated transient one sided weakness. His parents were second cousins. His father died of stroke at the age of 46 years and his mother dies of a severe asthma attack aged 52 years. His 33 year old sister did not have a history of any neurological disorders.
He first experienced right hemiparesis and contralateral visual blurring at 20 years of age. This was not accompanied by headache. These symptoms continued for seven days and then resolved spontaneously. Since then he had had similar episodes almost monthly. The affected side had varied with each attack. Weakness was worse on standing but without significant orthostatic hypotension. He recovered completely within three to seven days. On one occasion after ingesting Cafergot, a preparation of ergotamine with caffeine, when aged …