title: Stroke intervention for middle cerebral artery thrombus in a young patient with an ipsilateral Spetzler-Martin grade V arteriovenous malformation.
abstract: A patient (in their late 20s) was admitted with a right frontal stroke, left hemiparesis and hemianopsia, and a National Institutes of Health Stroke Scale (NIHSS) score of 11. CT perfusion imaging revealed an ischemic penumbra. A CT angiogram showed a Spetzler-Martin grade V arteriovenous malformation (AVM) in the right frontal lobe and a second, smaller AVM in the medial occipital region. Successful mechanical thrombectomy for middle cerebral artery thrombi improved flow from a Thrombolysis in Cerebral Infarction score of 0 to 2b. Following endovascular mechanical thrombectomy, the NIHSS dramatically improved from 11 to 2 and the patient was discharged home in 7 days. Evaluation 1 month after treatment disclosed a nearly complete recovery, with mild residual arm weakness (NIHSS 1). This case illustrates acute stroke intervention in the setting of an ipsilateral, large, high flow AVM in a young adult and is the first such reported case to our knowledge.
authors.affiliation: Department of Neurosurgery and Toshiba Stroke Research Center, USA.
authors.forename: Adib A
authors.initials: AA
authors.lastname: Abla
authors.forename: Travis M
authors.initials: TM
authors.lastname: Dumont
authors.forename: Peter
authors.initials: P
authors.lastname: Kan
authors.forename: L Nelson
authors.initials: LN
authors.lastname: Hopkins
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
mesh_terms: D000328:Adult; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000601:surgery; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000601:surgery; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000601:surgery; D011859:Radiography; D020521:Stroke / Q000000981:diagnostic imaging* / Q000601:surgery; D016896:Treatment Outcome