A 28-YEAR-OLD MAN had sudden-onset motor aphasia, progressive somnolence, and right-sided motor hemiparesis 3 hours after intense soccer playing. On admission to our neurology department 1 hour after symptom onset, the results of a computed tomographic scan were normal, and duplex ultrasonography showed a partially occluding thrombus (Figure 1), extending from the left carotid bifurcation 3 cm into the internal carotid artery. Clinically, the patient's somnolence and right-sided hemiparesis worsened, and he underwent immediate thromboendarterectomy in the Department of Vascular Surgery, Technical University of Munich, Munich, Germany.
A transverse ultrasonogram shows a partially occluding thrombus (arrowheads) extending from the left carotid bifurcation 3 cm into the internal carotid artery.
Histological examination revealed fresh thrombotic material (arrow) adhering to a ruptured atherosclerotic plaque. Both fibrotic intimal thickening (2 asterisks) and granulation tissue with chronic inflammatory cell infiltrates (asterisk) at the rupture site are shown (van Gieson solution of trinitrophenol and acid fuchsin, original magnification ×100).
A transversal magnetic resonance image (T2-weighted fluid-attenuated inversion recovery) shows several cortical infarcts within the territory of the left middle cerebral artery. Figure courtesy of Helga von Einsiedel, MD, Munich, Germany.
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