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Case 11

S Kosteniuk, L Resch

University of Calgary

A previously healthy 36 year old woman presented with sudden onset severe right head and neck pain, followed by left hemiplegia, left facial droop, dysarthria, and confusion. CT angiography revealed occlusion of the right cavernous ICA and proximal MCA, and early ischemic changes in the right frontal lobe. Endovascular thrombectomy of the M1 was achieved, though distal occlusions and subarachnoid hemorrhage developed during the procedure. The patient developed further ischemic foci, diffuse cerebral edema, and transtentorial and uncal herniation. Despite decompressive hemicraniectomy, her neurological status deteriorated. The patient died two days after initial presentation.


Materials Submitted: Right ICA (proximal),  one H&E from distal right ICA, one H&E from hilar lymph node


Questions: Diagnosis?