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Images in Neurology
Aug 2011

Intra-arterial Thrombus Visualized on Magnetic Resonance Imaging in Internal Carotid Artery Occlusion

Author Affiliations

Author Affiliations: Departments of Neurology (Drs Ha and Park), Radiology (Dr Byun), and Emergency Medicine (Drs Lee and Kim), Chung-Ang University College of Medicine, Seoul, South Korea.

Arch Neurol. 2011;68(8):1076. doi:10.1001/archneurol.2011.165

A 79-year-old woman was taken to the emergency department 30 minutes after the onset of right hemiparesis, which resolved after intravenous injection of tissue plasminogen activator. Enhanced magnetic resonance (MR) angiography performed 2 hours after symptom development showed occlusion of nearly the entire internal carotid artery (ICA) (Figure, A). Diffusion-weighted MR imaging showed high-signal-intensity lesions in the left temporo-occipital lobe (Figure, D), and perfusion delays were seen in the posterior cerebral artery territory on perfusion-weighted MR imaging. The left cervical, petrosal, and cavernous carotid artery segments showed high signal intensities on fluid-attenuated inversion recovery (FLAIR) imaging. However, the supraclinoid portion giving off the posterior communicating artery revealed isointensity (Figure, B). Susceptibility-weighted imaging, contrast-enhanced T1-weighted imaging, and follow-up computed tomographic angiography suggested that thrombus was located only in the distal segment of the ICA.

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