PMC8473712_01
An axial view of a non-contrast computed tomography scan showing multiple areas of acute and subacute ischemic strokes in different territories.
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Due to a high suspicion of acute cerebrovascular insult, a non-contrast cerebral neuroimaging via computed tomography (CT) (Figure 1) was performed and showed multiple areas of acute and subacute ischemic stroke in different territories including the posterior cerebral artery (PCA), superior cerebellar artery (SCA), posterior inferior cerebellar artery (PICA), and anterior inferior cerebellar artery (AICA) bilaterally.
An axial view of computed tomography angiography scan showing a donut sign in the left vertebral artery, suggestive of free-floating thrombus at the level of V1.
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The cerebral CT-angiogram (CTA), from arch to vertex, showed a long segment of filling defect in the left vertebral artery, extending from V0 up to V2 segments, which is suggestive of a long, fresh, free-floating thrombus with the classical donut sign appearance (Figures 2 and 3).
A coronal view of computed tomography angiography scan showing a long, fresh, free-floating thrombus in V1 and V2.
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The cerebral CT-angiogram (CTA), from arch to vertex, showed a long segment of filling defect in the left vertebral artery, extending from V0 up to V2 segments, which is suggestive of a long, fresh, free-floating thrombus with the classical donut sign appearance (Figures 2 and 3).
A coronal view of computed tomography angiography scan, showing complete canalization of the thrombus in the left vertebral artery 7 days post initiation of therapy.
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The CTA follow-up (Figure 4) and doppler sonography showed complete canalization of the thrombus in the left vertebral artery.
An axial view of a follow-up magnetic resonance imaging scan showing multiple areas of acute and subacute ischemic strokes in different cerebellar territories, with no additional cerebrovascular insults to the initial non-contrast computed tomography scan.
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In addition, the follow-up neuroimaging via magnetic resonance imaging (MRI) showed no new ischemic insult in comparison to the initial cerebral CT (Figure 5).