by
Dr. G.N. Lakshminarayan
This
39 yrs old moderately obese woman reported to me a month ago with pain and
cramps of the right side of the body of 10 days duration. Since she had lots of
family problems and the symptoms was a positive one, I dismissed her saying she
won’t develop a stroke. She lost her father 10 days later due to CRF. Four
days ago,she was admitted to the hospital for weakness of the right side and
slurring of speech of two days duration. MRA showed a thrombus in the left
carotid bifurcation. She was managed conservatively when she showed improvement
but yesterday she again developed more slurring of speech and weakness of the
right side. The MRA was shown to an interventional radiologist who prepared to
stent the left carotid. But after angiogram, he refused stenting saying it is
dangerous because of the loosely lying thrombus and advised CEA. Promptly she
was taken up for CEA which went on well. She is recovering. Antiphospholipid
abs, rheumatology and cardiac workup, and clotting cascade are normal.
I
only felt sad because it was me who assured her that she won’t develop a
stroke.
Lakshminarayan
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(c) 2006 M.H. Rivner
revised
10/23/2006