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Carotid artery stenosis after radiotherapy

I was diagnosed with a stage III oropharyngeal squamous cell carcinoma in January 2019. I started my treatment with Cisplatin and daily radiotherapy in March 2019. I completed my radiotherapy and my final Cisplatin in May 2019.

I had a percutaneous endoscopic gastrostomy (PEG) during treatment and the expected side effects associated with my treatment.

Over the following years I made a good recovery and to a great extent it would have been difficult to know that I had cancer at all.

I had however, since 2022, been suffering from right sided headaches, and with increasing severity and regularity. I consulted with my GP and after trying numerous medications, unsuccessfully, was referred to neurology. A virtual consultation (i.e. a written response to my GP’s referral) determined that there was little worry about and that they were probably migraines, tension or stress related.

In March 2023, whilst enjoying a weekend away with my partner, I suffered an episode of aphasia or an inability to ‘get my words out’. I knew what I wanted to say but was unable to express myself.

I consulted my GP but a neurological examination revealed nothing of note. I believe I had another related episode where I collapsed with no recollection of what had happened.

In June of this year (2024) I was enjoying a weekend away with friends when I experienced dizziness and temporary blindness in my right eye. This happened on three separate occasions within twenty four hours. I attended the Emergency Department where my history and recent events suggested amaurosis fugax1 as a result of a transient ischaemic attack (TIA)2. A CT scan was performed on the right side of my neck revealing severe stenosis of the Internal Carotid Artery (ICA)3.

I was admitted briefly to the Clinical Decision Unit before being sent home on medication to await an urgent Vascular review. I was seen the following week by Vascular Surgery and a month later admitted for a Carotid artery stent.

Following my stent procedure I have no headaches and have suffered no further episodes of vision loss or aphasia.

Ian Fernie

 

  1. Amaurosis fugax is a temporary loss of vision in one or both eyes due to a lack of blood flow to the retina.
  2. A transient ischaemic attack (TIA) is often called a mini stroke or mild stroke. The symptoms are very similar to those of a full-blown stroke, but they only last for a short time, anything from a few minutes up to 24 hours.
  3. Carotid artery stenosis is a narrowing of the large arteries on either side of the neck. These arteries carry blood to the head, face, and brain.