IMAGES IN NEUROLOGY “Hyperechogenic Rim” Sign in Internal Carotid Artery Thrombus DHERENT INTERNAL completely dissolved within the fol- its size remained unchanged (Figure carotid artery (ICA) lowing 3 to 5 days. 1E),thethrombusdemonstratedahy- thrombi constitute a Patient 1 was a 59-year-old man poechogenic core surrounded by an rare entity in pa- withhypertensionwhowasasmoker. obvious hyperechogenic rim (Figure A tients with stroke. ThepatienthadawakenedwithBroca 1F, arrowheads), probably reflecting Management, whether surgical dysphasiaandarightfaciobrachialsen- changes in its consistency. Within 5 (thrombectomy) or conservative sorimotor deficit (National Institutes days,thethrombushadcompletelydis- (anticoagulation), still relies on the of Health [NIH] Stroke Scale score of solvedwithoutcomplications(Figure experience and personal beliefs of 6). Cranial computed tomography 1G and H) and the patient improved the treating physician. We describe (CT) with perfusion 5 hours later progressively during the following 2 2 patients who were treated with in- showedacuteleftfrontoparietalische- weekswhilereceivingintravenoushep- travenous heparin sodium. In these mia. Color Doppler flow imaging re- arin therapy (NIH Stroke Scale score patients, serial carotid ultrasound ex- vealedanisoechogenictohyperecho- of 2, modified Rankin scale score of 1 amination findings demonstrated genicthrombusintheleftcarotidbulb at days 7 and 14). Findings on echo- changes in the consistency of the (Figure1A,arrows)extendingtothe cardiography showed a minor patent thrombi and, in particular, demon- proximalICA(Figure1B).Computed foramen ovale.
JAMA Neurology – American Medical Association
Published: May 1, 2004
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