A rare case of non-conventional risk factors for ischemic stroke: A long pathogenic sequence, neurointervention combined with IV acetylsalicylic acid and secondary prevention

Abstract

A 53-year-old man presented with acute ischemic stroke, NIHSS score of 7, 28 days after traumatic subdural haematoma and 8 days after haemothorax surgery. The MRI, MRA, and cerebral angiography revealed a thrombotic occlusion of the left middle cerebral artery (MCA), M2 segment. A significant laboratory abnormality was platelet count of 784 x109/l. Endovascular treatment using Penumbra thrombectomy system and 500 mg aspirin was applied intra-arterially to enhance recanalization. Final TICI 2b/3 result was achieved and onset-to-recanalization time was 260 min. In our center, this was the first patient with acute cerebral artery occlusion treated successfully during neuro-intervention with intra-arterial application of 500 mg aspirin. On control MRI, DWI core area was not enlarged after the intervention. The patient was discharged on day 8, and on 90 days his NIHSS and mRS scores were 0. In the pathogenesis of this stroke, some non-traditional causes were discussed: post-traumatic subdural haematoma and haemothorax, surgery, as well as reactive thrombocytosis and hyperhomocysteinaemia. On 3rd month follow-up, the transcranial colour coded doppler examination detected abnormal blood flow velocities in the left MCA, M1 segment, consistent with moderate to high-grade intracranial stenosis, which was verified by cerebral CT angiography. Secondary stroke prevention of the patient was guided in accordance with clarified etiologic mechanisms and additional risk factors.

Keywords

• Rare cause of acute ischemic stroke
• Thrombocytosis
• Endovascular mechanical thrombectomy
• Intra-arterial aspirin application
• Secondary stroke prevention