We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
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.
Text Size: A A A
Published online


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.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption

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).

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

2 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles