Case of the Week – Stroke Alert

This Case of the Week is in honor of May being Stroke Awareness Month.

A 70-year old man with a past medical history of a recent stroke status post thrombectomy presented to the emergency department with a sudden onset of left upper and lower extremity paralysis as well as facial droop with right-sided gaze preference. Patient’s wife had quickly recognized the symptoms of an acute stroke and had called 9-1-1.

ED physician ordered a CT brain, CTA brain, CTA neck, and CT brain perfusion using the stroke alert protocol. NIH Stroke Scale/Score (NIHHS) score was 15. One of our diagnostic radiologists, Dr. James Banks, MD, diagnosed the patient with a right carotid terminus thrombosis (blood clot) and carotid bifurcation stenosis. There was an associated middle cerebral artery territory core infarct and large surrounding ischemic penumbra that needed to be treated quickly in order to reverse any potential brain damage. Patient was not a tPA candidate.

Patient was immediately sent to the biplane room for a thrombectomy and possible internal carotid artery (ICA) and common carotid artery (CCA) stenting. Dr. Alejandro Santillan, one of our neurointerventional surgeons, performed an ICA and CCA reconstruction with two overlapping stents followed by thrombectomy of the right ICA terminus with complete reperfusion of the right hemisphere. Thrombolysis in cerebral infarction (TICI) of 3.

After the procedure, the patient had no neurological deficits. NIHHS of 0. Our clinic will follow-up with the patient now that he has been discharged to ensure he receives regular brain scans to look for new or developing stenosis that could cause additional strokes.

Learn more about strokes on our website:

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