Kutsuna Fumiya, Yamashita Kairi, Kanamoto Tadashi, Kurohama Hirokazu, Tateishi Yohei, Tsujino Akira
Department of Neurology and Strokology, Nagasaki University Graduate School of Biomedical Sciences.
Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences.
Rinsho Shinkeigaku. 2021 Oct 28;61(10):671-675. doi: 10.5692/clinicalneurol.cn-001616. Epub 2021 Sep 25.
An 86-year-old man was admitted for the abrupt onset of right hemiparesis and aphasia. DWI revealed the high intensity legion in the left insular cortex, and MRA demonstrated the left middle cerebral artery occlusion. Recanalization of the artery was not achieved after mechanical thrombectomy. The diagnosis of infective endocarditis was made as Enterococcus faecalis was cultured from the blood, and mobile vegetation was detected at the aortic valve by transthoracic echocardiography. The patient died from multiple organ failure at 19 days. Autopsy findings revealed fibrin-rich thrombus in the left middle cerebral artery containing neutrophils and bacteria. At the occluded site, neutrophils had intensively infiltrated into the vessel wall, and endothelial cells had partially disappeared. Moreover, disrupted internal elastic lamina was discovered. These findings could indicate that the thrombus had adhered to the vessel wall. The adhesion of the thrombus and vessel wall could be associated with unsuccessful recanalization after endovascular thrombectomy in patients with ischemic stroke due to infective endocarditis.
一名86岁男性因突发右侧偏瘫和失语入院。弥散加权成像（DWI）显示左侧岛叶皮质有高强度病灶，磁共振血管造影（MRA）显示左侧大脑中动脉闭塞。机械取栓术后动脉未实现再通。血液培养出粪肠球菌，经胸超声心动图在主动脉瓣检测到活动的赘生物，从而诊断为感染性心内膜炎。患者在19天时死于多器官功能衰竭。尸检结果显示，左侧大脑中动脉有富含纤维蛋白的血栓，其中含有中性粒细胞和细菌。在闭塞部位，中性粒细胞大量浸润到血管壁，内皮细胞部分消失。此外，发现内弹性膜破裂。这些发现可能表明血栓已附着于血管壁。在感染性心内膜炎所致缺血性卒中患者中，血栓与血管壁的附着可能与血管内取栓术后再通失败有关。
