Acute Bilateral Internal Carotid Artery Occlusion Presenting with Symmetric Cortical Infarctions Exhibits Dramatic Improvement After Mechanical Thrombectomy.

Abstract

Acute bilateral internal carotid artery (ICA) occlusion has rarely been reported to exhibit an improvement in prognosis. Herein, we report a case of acute bilateral ICA occlusion presenting with bilateral symmetric cortical and basal-ganglia infarctions that exhibited dramatic improvement after a mechanical thrombectomy. The patient was a 72-year-old man with a history of hypertension who presented with a coma and quadriplegia during sleep and experienced moderate vomiting and diarrhea the day before admission to our hospital. Neurologic examination revealed that the patient was in a coma (National Institutes of Health Stroke Scale 35). A brain computed tomography (CT) scan showed a hypodense lesion in the bilateral frontal cortex. An emergency cerebral angiography demonstrated complete occlusion of the bilateral ICA. Subsequently, a mechanical thrombectomy of the bilateral ICA was successfully performed. At a 3-month follow-up, the patient had residual slight aphasia and quadriparesis (National Institutes of Health Stroke Scale 16). Bilateral ICA occlusion should be considered if a patient presents with a coma, quadriplegia, and symmetric cortical infarctions. In such a case, a bilateral mechanical thrombectomy may represent a potential treatment for improving the prognosis of the affected patient.