Abstract
Internal carotid artery dissection (ICAD) is an important cause of acute ischemic stroke in younger patients. Potential acute treatments include anticoagulation, intravenous thrombolysis (IVT), and endovascular thrombectomy (ET). We report a case where the use of IVT followed by ET resulted in a good clinical outcome in a patient with tandem internal carotid and middle cerebral artery occlusion following ICAD.
Highlights
A 31-year-old right-handed woman, who was 4-month postpartum, presented to the emergency department with a thirty-five-minute history of left-sided face, arm and leg weakness, along with slurred speech
Acute treatment of stroke due to arterial dissection and occlusion is a challenge in clinical practice
Treatment guidelines do not advise against intravenous thrombolysis (IVT) in proximal artery occlusion (PAO) with internal carotid artery (ICA) dissection, but PAO is an independent predictor of poor outcome after IVT [4, 5]
Summary
CT brain imaging performed 1 hour after symptom onset showed a hyperdense middle cerebral artery (MCA) sign (Figure 1(a)), and CT angiogram showed a right internal carotid artery dissection (ICAD). MRI confirmed the internal carotid artery dissection and demonstrated restricted diffusion limited to the lenticulostriate distribution of the MCA. The intravenous thrombolysis (IVT) was initiated 2 hours 20 minutes following symptom onset, but following IV tPA administration the patient continued to display persistent left hemiparesis, dysarthria, and sensory inattention.
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