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Images in Neurology |

Acute Cerebral Ischemia Owing to Unruptured Dissecting Intracranial Aneurysm An Uncommon Contraindication for Intravenous Thrombolysis

Georgios Tsivgoulis, MD; Konstantinos Vadikolias, MD; Ioannis Heliopoulos, MD; Michalis Mantatzis, MD; Vasileios Souftas, MD; Charitomeni Piperidou, MD
Arch Neurol. 2010;67(6):770-771. doi:10.1001/archneurol.2010.90.
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A 25-year-old woman with an unremarkable medical history had an episode of acute weakness of her right arm and speech disturbance that had developed during the past 2 hours. She complained that she had also previously (during the last 8 hours before the onset of the last episode) experienced numerous episodes of transient right-arm weakness, which lasted only a few minutes and resolved spontaneously. She was evaluated by our acute stroke team as a potential candidate for intravenous thrombolysis. Her neurologic examination disclosed right hemiparesis and mild expressive aphasia, with a National Institutes of Stroke Scale score of 6 points.

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Figure.

Neuroimaging findings. A, Noncontrast brain computed tomogram (CT) showing segmental hyperattenuation of left middle cerebral artery (MCA) (arrows). B, Contrast brain CT showing aneurysmal dilatation in proximal aspect of left MCA. C, Transcranial color-coded sonogram (left transtemporal insonation, axial midbrain plane) depicting aneurysmal dilatation (arrows) in left distal M1 section of MCA (depicted as red color band; left anterior cerebral artery depicted as blue color band). Note the intrasaccular turbulent flow (alternating blue and red colors inside aneurysm lumen). D, Digital subtraction angiogram (left anterior oblique projection) confirming a giant (maximum diameter, 33 mm), dissecting, left MCA aneurysm. Note multiple distal MCA branches originating from the dome of the aneurysm, including the external lenticulostriate arteries. E, Brain magnetic resonance image (MRI) showing hyperintense ischemic lesion affecting left basal ganglia. F, Gadolinium-enhanced brain MRI (coronal sequence) depicting tail of aneurysm (arrow).

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