Carotid Thrombosis in a Crack Cocaine Smoker Woman

Abstract

Introduction: We report a case of stroke in a crack smoker with occlusion of the middle cerebral artery and a large thrombus in the carotid artery. Case Presentation. A 34-year-old female presented with left upper arm weakness, associated with paresthesia with onset of symptoms more than 24 hours before. Angio-RM sequences showed an area of ischemia, with occlusion of the M2 segment of the middle cerebral artery. Carotid ultrasound showed a soft plaque with distal end floating. Anticoagulant treatment was started, and seriated ultrasound evaluations showed its gradual dissolution.

Conclusions: In atherothromboembolic stroke from carotid thrombosis, repeated ultrasound studies may be useful for either diagnosis and monitoring the efficacy of anticoagulant therapy.

Figure 1

(a, b) A huge homogeneous soft plaque with irregular surfaces and circumferential blood flow at the distal end along carotid bifurcation. (c) Image at 1 week after starting therapy. (d) Image at 2 weeks after anticoagulant.