Simultaneous bilateral internal carotid artery occlusion: a case report and review of literature

Bilateral ICA occlusion is a rare stroke syndrome presenting with acute onset coma with intact brainstem functions. We report herein a typical example of acute simultaneous bilateral ICA occlusion case along with a meta-analysis of all cases reported since its first description in 1954. A 83-year-old woman with known hypertension and lung cancer presented to the emergency department with sudden onset coma. On CT angiography, bilateral internal carotid artery acute occlusion was detected, and the patient was transferred immediately into the angiography suit for endovascular treatment. Recanalization couldn't be achieved, and the patient expired on second day after admission. Our meta-analysis included 25 patients from 18 different case reports. The mean age was 57 +- 20 years, the mortality rate was 62.5% and the most common stroke risk factors were hypertension and smoking. The patients presented mostly with lateralizing hemispheric signs (56%) and imaging studies showed bilateral lesions in 72% of the cases. Based neuroimaging studies, we concluded that the mechanism of stroke was malignancy induced hypercoagulability. Acute bilateral carotid artery occlusion is a moribund condition without timely and effective recanalisation. But, difficulties in differentiation from metabolic comas and massive posterior circulation strokes often lead to delayed treatment.