Smoothly progressive cerebral infarction over three weeks: Clinicopathological study in a patient with carotid occlusion.
We report an 80-year-old patient with internal carotid artery (ICA) occlusion and smoothly progressive worsening of neurological and neuropsychological dysfunction over 3 weeks despite intravenous heparin anticoagulation. At autopsy, there were multiple small [nonvisible on computed tomography (CT)] and large (seen on CT) infarcts distal to the occluded ICA. They corresponded to multiple embolic arterial occlusions throughout the hemisphere. These findings show that smoothly progressing stroke associated with ipsilateral ICA occlusion may be due to relentless, iterative artery-to-artery embolism rather than to hemodynamic compromise. They also cast doubts on the potential usefulness of anticoagulation in this situation.
From the Department of Neurology, CHUV, Laussane, Switzerland.
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Bogousslavsky
The University Institute of Pathology (Division of Neuropathology), Laussane, Switzerland.
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Miklossy