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Case Reports
. 2014 May 9;6(2):144-8.
doi: 10.1159/000362160. eCollection 2014 May.

Sudden coma from acute bilateral m1 occlusion: successful treatment with mechanical thrombectomy

Uwe Dietrich  1 , Tilmann Graf  2 , Wolf-Rüdiger Schäbitz  2
Affiliations
Case Reports

Sudden coma from acute bilateral m1 occlusion: successful treatment with mechanical thrombectomy

Uwe Dietrich et al. Case Rep Neurol. .

Abstract

We report a case with acute small infarct of the left middle cerebral artery in a 72-year-old man with atrial fibrillation documented by MRI and MR angiography. One hour later, he lost consciousness and CT with CT angiography revealed bilateral hyperdense middle cerebral arteries due to occlusion of the M1 segments. Mechanical thrombectomy of the right middle cerebral artery was successfully performed. During that time, thrombosis on the left side had progressed to carotid T occlusion, which was recanalized as well. The patient had a good outcome with slight aphasia and mild paresis of the left hand and could be transferred to rehabilitation 2 weeks later.

Keywords: Bilateral M1 occlusion; Coma; Mechanical thrombectomy; Stroke.

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Figures

Fig. 1
Fig. 1
a MRI 2 days after the clinical onset of symptoms reveals small acute infarcts of the left frontal operculum on DWI. b TOF angiography shows lack of flow enhancement in the bifurcation of the left middle cerebral artery suggesting intraluminal thrombus.
Fig. 2
Fig. 2
Three hours later, the patient was in a coma and bilateral hyperdense middle cerebral arteries were seen on nonenhanced CT scans (arrows, a) with bilateral M1 occlusion confirmed by CT angiography (arrows, b).
Fig. 3
Fig. 3
Angiography of the right internal cerebral artery shows M1 occlusion (a) and revascularization after thrombectomy (b). Angiography of the left side revealed carotid T occlusion with intraluminal thrombotic material (c) and the final result after four passes with the stent retriever (d).
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