Risk factors of ischemic stroke/transient ischemic attack in young women: A case report


  • Elmira Mamytova
  • Aliya Kadyrova
  • Dzhamalbek Turgumbaev
  • Emir Zholdoshev
  • Yethindra Vityala
  • Tugolbai Tagaev




Lacunar stroke, ischemic stroke, oral contraceptive, circle of Willis, hypoplasia


This case report aims to demonstrate the clinical significance of the left internal carotid artery (ICA) hypoplasia in a young woman who received a combined oral contraceptive (COC) and its association with arterial occlusion and the development of a lacunar stroke/lacunar cerebral infarct (LACI). Brain magnetic resonance imaging (MRI) of the left frontal lobe revealed multiple subcortical and periventricular amplification/ischemia foci (49.0×17.0 mm), and lacunar infarct loci (2.0×4.0 mm). Brain magnetic resonance angiography revealed a markedly narrowed lumen of the left ICA (2.0–3.0 mm). MRI diffusion-weighted imaging-fluid attenuated inversion recovery revealed a moderate diffuse wall thickening and reinforcement of the left ICA. The patient was diagnosed with LACI and congenital hypoplasia of the left ICA and underwent antiplatelet drug therapy (aspirin - 100 mg) and a complete withdrawal of COC. A full amelioration of neurological symptoms was observed after one month of treatment.

Author Biographies

Elmira Mamytova

A.N. Murzaliev Department of Neurology and Clinical Genetics, I.K.Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan

Aliya Kadyrova

Department of Radiology, I.K. Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan

Dzhamalbek Turgumbaev

Department of Neurology, Neurosurgery and Psychiatry, S.B. Daniyarov Kyrgyz State Medical Institute for Retraining and Advanced Studies, Bishkek, Kyrgyzstan

Emir Zholdoshev

Department of Pathology, International Higher School of Medicine, International University of Kyrgyzstan, Bishkek, Kyrgyzstan

Yethindra Vityala

Department of Pathology, International Higher School of Medicine, International University of Kyrgyzstan, Bishkek, Kyrgyzstan

Tugolbai Tagaev

Department of Hospital Internal Medicine, Occupational Pathology with a Course of Hematology, I.K. Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan


Ahmed, S. B., Hovind, P., Parving, H-H., Rossing, P., Price, D. A., Laffel, L. M., et al., Oral contraceptives, angiotensin-dependent renal vasoconstriction, and risk of diabetic nephropathy. Diabetes Care. 2005; 28(8): 1988-1994.

Chan, W. S., Ray, J., Wai, E. K., Ginsburg, S., Hannah, M. E., Corey, P. N., et al., Risk of stroke in women exposed to low-dose oral contraceptives: a critical evaluation of the evidence. Arch Intern Med. 2004; 164(7): 741-747.

Ciccone, A., Melis, M. Ischemic stroke risk in oral contraceptive users. Stroke. 2003; 34(12): e231.

Gillum, L. A., Mamidipudi, S. K., Johnston, S. C. Ischemic stroke risk with oral contraceptives: A meta-analysis. JAMA. 2000; 284(1): 72-78.

Chen, C. J., Chen, S. T., Hsieh, F. Y., Wang, L. J., Wong, Y. C. Hypoplasia of the internal carotid artery with intercavernous anastomosis. Neuroradiology. 1998; 40(4): 252-254.

Gunawansa, N. Hypoplastic Ipsilateral Internal Carotid Artery as a Cause of Acute Ischemic Stroke: A Case Report. World J Surg Surgical Res. 2018; 1: 1060.

Roach, R. E., Helmerhorst, F. M., Lijfering, W. M., Stijnen, T., Algra, A., Dekkers, O. M. Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke. Cochrane Database Syst Rev. 2015; 2015(8): CD011054.

Staikov, I., Stoyanov, I., Staneva, M., Neykov, N., Kirova, G., Polomski, P., et al. Diagnostic value of color-coded duplex sonography in patients with ischemic stroke and congenital changes in the circle of Willis. Cor et Vasa. 2016; 58(6): e591-e599.

Mujagi?, S., Kozi?, D., Huseinagi?, H., Smajlovi?, D. Symmetry, asymmetry and hypoplasia of the intracranial internal carotid artery on magnetic resonance angiography. Acta Med Acad. 2016; 45(1): 1-9.

Wassertheil-Smoller, S., Hendrix, S. L., Limacher, M., Heiss, G., Kooperberg, C., Baird, A., et al. Effect of estrogen plus progestin on stroke in postmenopausal women: The Women's Health Initiative: a randomized trial. JAMA. 2003; 289(20): 2673-2684.

Kemmeren, J. M., Tanis, B. C., van den Bosch, M. A., Bollen, E. L., Helmerhorst, F. M., van der Graaf, Y., et al. Risk of Arterial Thrombosis in Relation to Oral Contraceptives (RATIO) study: oral contraceptives and the risk of ischemic stroke. Stroke. 2002; 33(5): 1202-1208.

Lidegaard, O., Kreiner, S. Contraceptives and cerebral thrombosis: a five-year national case-control study. Contraception. 2002; 65(3): 197-205.

Lidegaard, O. Smoking and use of oral contraceptives: impact on thrombotic diseases. Am J Obstet Gynecol. 1999; 180(6 Pt 2): S357-S363.




How to Cite

Mamytova E, Kadyrova A, Turgumbaev D, Zholdoshev E, Vityala Y, Tagaev T. Risk factors of ischemic stroke/transient ischemic attack in young women: A case report. Biomedicine [Internet]. 2021 Apr. 3 [cited 2023 Feb. 8];41(1):160-2. Available from: https://biomedicineonline.org/index.php/home/article/view/555

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