To describe the clinical and imaging features of carotid web (CW) as a rare cause of ischemic stroke.

CW is an atypical form of fibromuscular dysplasia (FMD). The main radiological finding is a shelf-like intraluminal filling defect in the carotid bulb. CW is a rare cause of acute ischemic stroke in young patients and is often misdiagnosed.

We describe the clinical and imaging features of a young woman attended at Instituto Nacional de Ciencias Neurologicas (INCN) Lima, Peru. Also, we reported her one-year follow-up. IRB approval was obtained at INCN.

A 35-year-old woman with no cardiovascular risk factors complained of recurrent episodes of right arm weakness and expressive aphasia lasting about 30 seconds each. These symptoms have been present during the last four months. She presented to our hospital with five days acute onset of right side weakness and slurred speech. Her National Institutes of Health Stroke Scale was 13 and the magnetic resonance imaging revealed a left middle cerebral artery ischemic stroke with hemorrhagic conversion. Magnetic Resonance Angiography showed a short segment of linear filling defect in the distal left intracranial carotid artery (ICA). Doppler ultrasound showed a membrane-like structure protruding into the lumen from the wall at the left ICA bulb. Conventional digital subtraction angiography revealed a left carotid web from the posterior ICA bulb wall with contrast stagnation. Workup was negative for vasculitis, hypercoagulability, and right to left intracardiac shunt. No abnormal rhythm was reported on cardiac monitor. She was discharged on conservative medical therapy with aspirin 100mg. No recurrence of stroke at one-year of follow-up.