Age: 50 Sex: Female History: Sudden onset of Right Hemiplegia and aphasia. Arrived in hospital within one hour. Examination showed Aphasia, Right Hemiplegia and eye deviation.

Pre-op X-Rays
CT head showing "hyperdense MCA sign" but no evidence of acute infarction.

Stat Cerebral angiogram, showing a tapering occlusion of the left ICA in the neck consistent with a disection, and very little colateral flow to the hemisphere, either via the anterior or posterior circulation.

Treatment

• PCA was catheterizedbut only to find a thrombosed left MCA.
• Partial lysis with intra-asterial T-pa over 30 minutes.
• Surgical re-opening of the dissected cervical carotid artery.
• Angio showed good flow but RAGGED ICA.
• STENTING done.

Result and Post-op CT

Patient survived. Post-op CT showed minimal left hemisphere infarction.

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