<% strPathPics = Session("strPathPicsL") imgBg = strPathPics + Session("strMedia") %> tpacase2b

Top of the Carotid Occlusion Treated with tPA

A 72 year-old woman presented with the acute onset of a left hemiplegia affecting the face, arm and leg, associated with a neglect syndrome and right eye deviation. After the initial CT showed no evidence of hemorrhage, IV tPA was administered followed by intra-arterial tPA. Two hours later, she was in a coma with bilateral Babinksi signs.

Note the Clot at the Top of the Carotid   Note the Flow in the ACA Post-tPA   Note the Flow in the MCA Post-tPA

Top of the Carotid Occlusion: Cerebral angiogram, AP view, right internal carotid artery injection; (Left) Pre-tPA; (Right) Post-tPA. On the pre-tPA film, note the occlusion at the top of the carotid artery with trivial filling of the anterior cerebral artery (ACA), and minimal filling of the middle cerebral artery (MCA). On the post-tPA film, the ACA is well seen as are some of the M2 and M3 branches of the MCA. ICA = Internal carotid artery.

Revised 11/22/06
Copyrighted 2006. David C Preston