Posterior Circulation Stroke After Subclavian Artery Thrombosis Following Low-Voltage Electrical Injury in an Active...

A 45-year-old active woman without previously known significant medical history presented with acute neurologic deficits (National Institutes of Health Stroke Scale (NIHSS) score 3) following a low-voltage electrical shock to her right arm three days earlier. Computed tomography angiography demonstrated a thrombus in the proximal right subclavian artery just distal to the origin of the right vertebral artery, while brain imaging revealed multifocal posterior circulation infarcts involving the left thalamus, left occipital lobe, and right cerebellar hemisphere. An extensive evaluation did not identify a cardiac source of embolism, intracardiac shunt, or convincing arterial dissection. Hypercoagulable testing identified heterozygous Factor V Leiden, and subsequent outpatient hematologic evaluation established a diagnosis of JAK2-mutated essential thrombocythemia (ET), revealing previously unrecognized prothrombotic risk factors. The patient was treated initially with intravenous unfractionated heparin and subsequently transitioned to rivaroxaban, with complete radiographic resolution of the subclavian thrombus and neurological recovery to NIHSS 0 and modified Rankin Scale (mRS) 0 at discharge. Following the diagnosis of ET, aspirin therapy was initiated, and she remained on rivaroxaban at the time of manuscript preparation. Although causality cannot be established, the temporal relationship and anatomic distribution raise the possibility that electrical injury acted as a vascular trigger in a patient with an underlying predisposition to thrombosis. This case emphasizes the importance of vascular imaging and evaluation for competing prothrombotic conditions when neurologic deficits develop following electrical injury.