Yasuda Ken, Ayaki Takashi, Kawabata Yasuhiro, Murase Nagako, Ohtani Ryo, Nakamura Michikazu
Department of Neurology, National Hospital Organization Kyoto Medical Center.
Department of Neurology, Kyoto University, Graduate School of Medicine.
Rinsho Shinkeigaku. 2019 Apr 25;59(4):195-199. doi: 10.5692/clinicalneurol.cn-001252. Epub 2019 Mar 30.
A 73-year-old women visited emergency department because of sudden right hemiplegia. She had a history of duodenum papilla cancer terminal stage and multiple liver metastasis. On admission, diffusion weighted images revealed high intensity area at left middle cerebral artery territory. In addition, 3D-TOF MRA depicted proximal part of the left internal carotid artery. We performed endovascular thrombectomy because low platelet count met contraindication of intravenous recombinant tissue plasminogen activator therapy. Although we could get partial recanalization of middle cerebral artery occlusion after thrombectomy, the patient eventually died due to multiple organ failure. Autopsy findings showed white thrombus on mitral valve and also left middle cerebral artery occluded by similar white thrombus without infective findings. The patient was finally diagnosed with nonbacterial thrombotic endocarditis due to white thrombus on the mitral valve. We should select appropriate mechanical thrombectomy devices with a case of cerebral infarction due to nonbacterial thrombotic endocarditis because its thrombus is often white thrombus and would be hard.
一名73岁女性因突发右侧偏瘫就诊于急诊科。她有十二指肠乳头癌终末期及多发肝转移病史。入院时，弥散加权成像显示左侧大脑中动脉供血区有高强度区域。此外，三维时间飞跃法磁共振血管造影显示左侧颈内动脉近端。由于血小板计数低符合静脉注射重组组织型纤溶酶原激活剂治疗的禁忌证，我们进行了血管内血栓切除术。尽管血栓切除术后大脑中动脉闭塞得到了部分再通，但患者最终因多器官衰竭死亡。尸检结果显示二尖瓣上有白色血栓，左侧大脑中动脉也被类似的白色血栓阻塞，无感染迹象。该患者最终被诊断为二尖瓣白色血栓导致的非细菌性血栓性心内膜炎。对于非细菌性血栓性心内膜炎所致脑梗死病例，我们应选择合适的机械取栓装置，因为其血栓通常为白色血栓且质地坚硬。
