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
Introduction: Management of intracranial pressure [ICP] represents a cornerstone in the care of traumatic brain injury [TBI] patients. On occasions, intoxicated TBI represent a clinical challenge since their initial imaging is not significantly correlating with elevated ICP yet their neurological exam concerns toward that possibility
Materials and Methods: We present an initial series of intoxicated TBI patients in which the trans-cranial Doppler [TCD] were conducted to noninvasively judge the ICP and correlate those with the clinical findings
Results: A total of four patients is reported in this series. About 50% of the patients had evidence of elevated ICP based on TCD parameters confirmed by ICP monitors
Conclusion: From our series, TCD screening examinations were helpful in expediting an objective guided decision for intracranial pressure monitoring