The disappearing thrombus: An uncommon cause of ischemic stroke

A 46-year-old woman presented with 2 episodes of transient left-sided paresis and hypoesthesia lasting 30 minutes. The emergency department initiated a stroke code due to reoccurrence of symptoms. Workup revealed a platelet count of 1,141,000, and CT angiography showed a large pedunculated thrombus within the right internal carotid artery (figure 1). She underwent emergent plateletpheresis without an anticoagulant (unfractionated heparin, low molecular weight heparin). This was not started at the time of initial presentation because of increased bleeding risk in patients with either reactive or essential thrombocythemia.1 Eighteen hours after initial presentation, repeat imagining showed resolution of the thrombus with small areas of acute ischemic infarcts (figure 2). It was thought that this was due to artery-to-artery emboli from the thrombus. Given that there was no hemorrhage on the imaging, she was started on 325 mg aspirin daily. Three days after presentation, she was discharged from the hospital without neurologic deficits. At last follow-up, 13 months poststroke, she does not have any neurologic deficits.
Source: Nature Clinical Practice - Category: Neurology Authors: Tags: Stroke in young adults, All Imaging, Embolism, Infarction Cases Source Type: research