The Neurologist

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doi: 10.1097/NRL.0b013e3181824741
Case Report

Case Report of a Patient Who Underwent Thrombolysis of a “Silent” Thrombus in the Middle Cerebral Artery

Idicula, Titto T. MD; Thomassen, Lars MD, PhD

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Introduction: Some stroke patients present with mild or absent measurable neurologic deficits in spite of a significant thromboembolic event. A thrombus in the distal region of the middle cerebral artery may have such a presentation. CT angiography in the acute phase helps to identify the culprit thrombus. Thrombolysis might be beneficial in these patients in spite of the lack of measurable neurologic deficits. We present a patient with a ‘silent' thrombus in the middle cerebral artery.

Case Report: A 70-year-old man presented with a history of fluctuating neurologic symptoms for 2 days. Neurologic examination at the time of presentation revealed no measurable deficits. CT angiography showed a thrombus in the M2 segment of the middle cerebral artery which was treated with intravenous thrombolysis. Patient did not have recurrence of symptoms after thrombolysis. MR angiogram a day after thrombolysis showed partial recanalization of the artery.

Conclusion: Some stroke patients with an intracranial thrombus may present with minimal or absent measurable neurologic deficits. CT angiography is a useful tool in identifying the thrombus. Intravenous thrombolysis may be beneficial in stroke patients presenting with a “silent” thrombus.

© 2009 Lippincott Williams & Wilkins, Inc.


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