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Images in Neurology |

Imaging Active Intracerebral Hemorrhage After Attempted Endovascular Thrombectomy

Saeed A. Alqahtani, MD1; Richard Leigh, MD1
[+] Author Affiliations
1National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
JAMA Neurol. 2016;73(6):754. doi:10.1001/jamaneurol.2016.0570.
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This case report describes a woman in her 70s with a history of atrial fibrillation who presented with slurred speech and difficulty ambulating for 1 hour.

A woman in her 70s with a history of atrial fibrillation presented with slurred speech and difficulty ambulating for 1 hour. Neurologic evaluation revealed dense left-sided hemiplegia, forced right gaze deviation, left facial droop, complete hemianopia, and severe dysarthria. Computed tomographic angiography identified an occlusive thrombus in the proximal segment of the right middle cerebral artery without intracerebral hemorrhage. Her international normalized ratio was less than 1.5. She was treated with intravenous thrombolysis and then taken for endovascular therapy. Multiple attempts to recanalize the vasculature using stent retrievers and aspiration devices were unsuccessful; only the proximal portion of the M1 segment of the middle cerebral artery was recanalized along with the lenticulostriate perforators.

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Basal Ganglia Hemorrhage After Endovascular Thrombectomy

A T2*-weighted image captured from the perfusion-weighted imaging source images shows a large (bright) intracranial hemorrhage in the right basal ganglia with the gadolinium bolus (dark) leaking from the vasculature into the hematoma.

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Basal Ganglia Hemorrhage After Endovascular Thrombectomy

Source images of the perfusion-weighted imaging show the bolus of gadolinium (dark) passing through the vasculature. Dark gadolinium is seen leaking from the vasculature and flowing into the bright parenchyma hematoma.

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