Images in Neurology |

Intra-arterial Thrombus Visualized on Magnetic Resonance Imaging in Internal Carotid Artery Occlusion

Sam Yeol Ha, MD; Kwang-Yeol Park, MD, PhD; Jun Soo Byun, MD, PhD; Dong Hoon Lee, MD; Chan Woong Kim, MD, PhD
Arch Neurol. 2011;68(8):1076. doi:10.1001/archneurol.2011.165.
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A 79-year-old woman was taken to the emergency department 30 minutes after the onset of right hemiparesis, which resolved after intravenous injection of tissue plasminogen activator. Enhanced magnetic resonance (MR) angiography performed 2 hours after symptom development showed occlusion of nearly the entire internal carotid artery (ICA) (Figure, A). Diffusion-weighted MR imaging showed high-signal-intensity lesions in the left temporo-occipital lobe (Figure, D), and perfusion delays were seen in the posterior cerebral artery territory on perfusion-weighted MR imaging. The left cervical, petrosal, and cavernous carotid artery segments showed high signal intensities on fluid-attenuated inversion recovery (FLAIR) imaging. However, the supraclinoid portion giving off the posterior communicating artery revealed isointensity (Figure, B). Susceptibility-weighted imaging, contrast-enhanced T1-weighted imaging, and follow-up computed tomographic angiography suggested that thrombus was located only in the distal segment of the ICA.

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Figure. Magnetic resonance and computed tomographic angiographic imaging in internal carotid artery occlusion. A, Enhanced magnetic resonance angiography suggests internal carotid artery occlusion between the proximal and distal internal carotid artery (arrows). Isointense signal (circle) is seen in the left distal internal carotid artery segment giving off the posterior communicating artery on fluid-attenuated inversion recovery imaging (B), and this part is not enhanced (circle) on contrast-enhanced T1-weighted imaging (C). D, Diffusion-weighted magnetic resonance imaging shows high-signal-intensity lesions in the left temporo-occipital lobe. E, Computed tomographic angiography 1 day later reveals thrombus (arrow).




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