Multimodality MRI and MRA for decision making in minor stroke: a case with internal carotid and distal middle cerebral artery occlusion.
We report the case of a 65-year-old man who presented with mild, rapidly improving stroke symptoms. Acute magnetic resonance imaging disclosed no diffusion abnormalities but a tandem internal carotid artery/distal middle cerebral artery occlusion associated with a large corresponding deficit on perfusion imaging. In addition, there was a cross-flow to the middle cerebral artery via the anterior communicating artery. Therefore, intravenous thrombolysis was initiated that led to rapid reopening of the middle cerebral artery and left the patient free of symptoms. Our observation highlights the possible benefit of systemic thrombolytic treatment even in the setting of an internal carotid artery occlusion and the substantial contribution of multimodal magnetic resonance imaging for a risk-benefit estimate.
Beitzke
Markus
M
Department of Neurology, Medical University of Graz, Graz, Austria. markus.beitzke@klinikum-graz.at
Enzinger
Christian
C
Beitzke
Dietrich
D
Niederkorn
Kurt
K
Offenbacher
Hans
H
Niederkorn-Duft
Margret
M
Fazekas
Franz
F
D000368:Aged; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D003657:Decision Making; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator