ABSTRACT
Free-floating thrombus (FFT) is a rare condition with unknown etiology as described by many case reports presented in previous literature. The patients usually present symptomatically while the other few patients remain asymptomatic and are usually discovered incidentally on computed tomography angiography (CTA). Most of the cases reported in the literature are of FFT in the internal carotid artery. We present a 59-year-old female as a case of FFT in the vertebral artery which was coincidently discovered on CTA in a patient initially presenting with an anterior circulation stroke. This case highlights the importance of early contrast-based vascular imaging in patients presenting with large vessel strokes that are cardioembolic in nature and the unique utilization of a direct aspiration first pass technique (ADAPT) for revascularization. Included herein an extensive review of the literature about the decision making in patients with FFT and a devised proposed practical approach to this entity.
ABSTRACT
Spinal epidural hematoma [SEH] is an uncommon condition. Spontaneous SEH, accounting for 0.3-0.9% of all spinal epidural space occupying lesions, instead is associated with risk factors [such as substantial soft trauma or coagulation abnormalities].The pathophysiology of spontaneous and idiopathic SEH is still under debate: There are only a few reports in literature of spontaneous evolving SEH with progressively increasing pain and neurological impairment
Magnetic resonance imaging may be inconclusive for differential diagnosis. Here, we present a 38-years old female on the 2nd trimester of her pregnancy preset with spontaneous spinal epidural hematoma with a sudden onset of weakness and back pain fallowed by a sudden paraplegia. MR imaging showed high intensity irregular dotted lesion seen in the lower thoracic region [T12], in addition, MRI revealed an intervertebral disk prolapse with a cord compression between [L3-L4] [L4-L5]
The Surgical treatment of the case, the patient underwent laminectomy and an evacuation of the hematoma by the neurosurgical team allowed a correct diagnosis but still paraplegic. Our aim is to discuss the clinical and radiological features and the treatment options