Bilateral middle cerebral artery occlusion after trauma

Abstract

Case: Male, 53 years old, was in a coma after being injured in a car accident on June 17, 1973. After 48 hours, there was a gradual response, and after four days, he was in a state of lethargy. Examination: The patient responds to pain stimulation, vital signs are normal, pupils are 2 mm, equal in size, light response is slow, fundus ignores papilledema or retinal hemorrhage. There was no external damage to the neck and no murmur was heard. Nervous system examination revealed right central facial paralysis, right hemiparesis, more obvious lower extremities, and positive Bartholin's sign on the right. Percutaneous puncture of the right brachial artery and left carotid angiography confirmed complete occlusion of bilateral middle cerebral arteries. The right middle cerebral artery was occluded just after giving rise to the frontal parietal ascending branch. The posterior and anterior arteries of the ipsilateral brain were filled well, and the arterial phase was prolonged with increased intracranial pressure. The left middle cerebral artery was completely occluded at its origin from the left internal carotid artery. The left posterior and anterior cerebral arteries were well filled