Presentation
Sudden onset of hemiplegia.
Patient Data
Non-contrast CT demonstrates a strikingly hyperdense right cavernous ICA and MCA. There is subtle loss / blurring of the grey-white matter differentiation of the insular cortex and right lentiform nucleus.
The patient went on to angiography which demonstrated stasis of contrast in the right internal carotid artery, with an abrupt cut off due to thrombus.
An endoluminal clot retrieval device (Merci) was employed. This was able to reestablish flow in the middle cerebral artery (not shown).
Case Discussion
Acute agressive management of thromboembolic stroke relies upon prompt presentation to hospital and rapid mobilization or relevant resources if at-risk cerebral tissue is to be saved by reperfusion. In this case, despite clot retrieval, a sizable right MCA territory stroke developed. The patient was eventually discharged to rehab.
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