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GLOBAL CEREBRAL INFARCTION DUE TO ACUTE CARDIOEMBOLIC ANTERIOR & POSTERIOR CIRCULATION OCCLUSION

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ESOC-2019

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Abstract

Background and Aims: Acute, simultaneous occlusion involving the bilateral major arteries of the anterior and posterior cerebral circulation is extremely rare. According to available data, bilateral ICA occlusions can occur at a frequency of < 0.27% of all acute ischemic strokes, however concurrent basilar or PCA occlusion has only been once before reported in the literature. Such strokes clinically, can often be misleading in the initial stages, leading to delays in initiating appropriate management. Methods: A case report of a patient with global cerebral infarction following acute occlusion of major arteries of the cerebral circulation. Results: A 67-year-old man with known history of congenital hypertrophic cardiomyopathy and atrial fibrillation on warfarin was brought to the ED after being found unresponsive and comatosed. His GCS on arrival was noted to be 3 with a sub-therapeutic INR of 1.5. CT head without contrast showed symmetric hyperdensity of the bilateral supraclinoid ICAs and the basilar artery . His CTA head and neck confirmed the findings of absence of flow in these arteries. IV tPA was deferred after being deemed outside the recommended therapeutic window. Mechanical thrombectomy was attempted with futility due to extensive clot burden. Post-operatively, patient had progressive loss of brainstem reflexes and global cerebral infarction was observed on repeat imaging. He was pronounced dead in the subsequent 24 hours. Conclusions: Cardioembolism can have devastating consequences and in rare situations, cause global infarction from an acute occlusion of major cerebral vessels. Ideal management in such cases is still unclear and prognosis remains exceedingly poor.

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© Copyright 2019 Morressier GmbH.
All rights reserved.