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Idiopathic Free-Floating Thrombus of the Common Carotid Artery

Published online by Cambridge University Press:  02 December 2014

Brian Silver ,
Irene Gulka ,
Michael Nicolle ,
Ramesh Sahjpaul  and
Vladimir Hachinski
Brian Silver
Affiliation:
Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
Irene Gulka
Affiliation:
Department of Neuroradiology, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada
Michael Nicolle
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada
Ramesh Sahjpaul
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada
Vladimir Hachinski
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada
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Abstract

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Background:

The observation of an intraluminal common carotid artery thrombus overlying a wall defect at ultrasonography or angiography is unusual. To our knowledge, there are no previous reports of a free-floating thrombus in the common carotid artery.

Case Report:

A 45-year-old woman who was previously healthy and on no medications presented with acute hemiparesis and aphasia. Following testing that included carotid duplex and trancranial Doppler ultrasonography, diffusion-weighted magnetic resonance imaging, and digital subtraction angiography, the patient underwent emergency open embolectomy. No underlying wall defect was seen at the time of imaging or surgery. No obvious hypercoagulable state could be identified. Her NIH Stroke Scale score improved from 26 at admission to 2 at three months and 1 at one year.

Conclusions:

Multimodal imaging may have improved diagnosis and management in this patient with a unique finding. The source of the thrombus remains obscure.

Résumé:

RÉSUMÉ:Introduction:

Il est inusité d'observer un thrombus intraluminal au niveau d'une lésion de la paroi de la carotide primitive à l'échographie ou à l'angiographie. Ànotre connaissance, il n'existe pas de cas rapporté d'un thrombus flottant dans la carotide primitive.

Histoire de cas:

Une femme âgée de 45 ans, en bonne santé et ne prenant aucun médicament, a consulté pour une hémiparésie aiguë avec aphasie. Suite à une investigation comprenant un duplex carotidien, une échograplie Doppler transcrânienne, une résonance magnétique par diffusion pondérée et une angiographie digitalisée par soustraction, la patiente a subi une embolectomie ouverte d'urgence. Aucune lésion pariétale sous-jacente n'a été observée à l'imagerie ou à la chirurgie. Aucun problème d'hypercoagulabilité n'a été identifié. Son score au NIH stroke scale s'est amélioré, de 26 qu'il était à l'admission à 2 trois mois plus tard et à 1 après un an.

Conclusions:

L'imagerie multimodale a probablement aidé au diagnostic et au traitement de cette patiente porteuse d'une anomalie inusitée. La source du thrombus demeure obscure.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 29 , Issue 1 , February 2002 , pp. 97 - 99
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

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