Transient ischaemic attack (TIA) followed by aphasia

Free-floating thrombus in a stenotic supraclinoid left internal carotid artery: Description

An elderly woman presented with transient ischaemic attack (TIA) followed by aphasia the next day. MRI with angiogram showed watershed infarcts in the left middle and posterior cerebral artery territory and severe focal stenosis of the left supraclinoid internal carotid artery (ICA). She was started on aspirin 150 mg, clopidogrel 75 mg and atorvastatin 40 mg once daily. She persistently had multiple episodes of recurrent TIA despite dual antiplatelet therapy. Hence we planned to carry out digital subtraction angiography (DSA). DSA showed severe focal stenosis in the left supraclinoid ICA with free-floating thrombus (FFT) just distal to stenosis, yo-yoing with each heart beat (video 1). Thus enoxaparin 0.6 mL subcutaneous two times a day was added and continued on a domiciliary basis for 3 weeks. The patient, however, had three episodes of TIA despite being on enoxaparin, dual antiplatelet therapy and statin. DSA repeated at 3 weeks showed complete resolution of...

from #Med Blogs by Alexandros G.Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/1ULV7ZW
via IFTTT