Stroke intervention for middle cerebral artery thrombus in a young patient with an ipsilateral Spetzler-Martin grade V arteriovenous malformation.

Abstract

A patient (in their late 20s) was admitted with a right frontal stroke, left hemiparesis and hemianopsia, and a National Institutes of Health Stroke Scale (NIHSS) score of 11. CT perfusion imaging revealed an ischemic penumbra. A CT angiogram showed a Spetzler-Martin grade V arteriovenous malformation (AVM) in the right frontal lobe and a second, smaller AVM in the medial occipital region. Successful mechanical thrombectomy for middle cerebral artery thrombi improved flow from a Thrombolysis in Cerebral Infarction score of 0 to 2b. Following endovascular mechanical thrombectomy, the NIHSS dramatically improved from 11 to 2 and the patient was discharged home in 7 days. Evaluation 1 month after treatment disclosed a nearly complete recovery, with mild residual arm weakness (NIHSS 1). This case illustrates acute stroke intervention in the setting of an ipsilateral, large, high flow AVM in a young adult and is the first such reported case to our knowledge.

• Authors: Adib A Abla, Travis M Dumont, Peter Kan, L Nelson Hopkins, Adnan H Siddiqui, Elad I Levy
• Journal: Journal of neurointerventional surgery (J Neurointerv Surg) Vol. 5 Issue 2 Pg. e10 (Mar 2013) ISSN: 1759-8486 [Electronic] England
• PMID: 22345144 (Publication Type: Case Reports, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Endovascular Procedures (methods)
• Humans
• Infarction, Middle Cerebral Artery (diagnostic imaging, surgery)
• Intracranial Arteriovenous Malformations (diagnostic imaging, surgery)
• Middle Cerebral Artery (diagnostic imaging, surgery)
• Radiography
• Stroke (diagnostic imaging, surgery)
• Treatment Outcome