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Smoothly progressive cerebral infarction over three weeks: Clinicopathological study in a patient with carotid

J Bogousslavsky1, J Miklossy2

  • 1From the Department of Neurology, CHUV, Laussane, Switzerland.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|October 22, 2015
PubMed

Insights

Progressive stroke in internal carotid artery (ICA) occlusion may stem from artery-to-artery embolism, not just blood flow issues. Anticoagulation

Area of Science:

  • Neurology
  • Vascular Medicine
  • Pathology

Background:

  • Internal carotid artery (ICA) occlusion can lead to stroke.
  • Progressive neurological deficits suggest ongoing cerebrovascular events.
  • The underlying mechanism of stroke progression in ICA occlusion is debated.

Purpose of the Study:

  • To investigate the cause of smoothly progressive neurological dysfunction in a patient with ICA occlusion.
  • To determine the role of artery-to-artery embolism versus hemodynamic compromise.
  • To evaluate the efficacy of anticoagulation in such cases.

Main Methods:

  • Case report of an 80-year-old patient with ICA occlusion.
  • Clinical observation of neurological and neuropsychological dysfunction over 3 weeks.
  • Autopsy examination to identify infarcts and arterial occlusions.

Main Results:

  • The patient experienced progressive dysfunction despite heparin anticoagulation.
  • Autopsy revealed multiple embolic arterial occlusions and infarcts distal to the occluded ICA.
  • Small, non-CT-visible and large, CT-visible infarcts were identified.

Conclusions:

  • Smoothly progressing stroke in ICA occlusion may result from iterative artery-to-artery embolism.
  • Hemodynamic compromise might not be the sole or primary cause.
  • The utility of anticoagulation in this specific stroke progression pattern is questionable.

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