Malignant Hemispheric Stroke Secondary to Cavernous Internal Carotid Artery Stenosis in the Setting of Sepsis: A Case Report

This is a novel case of a rapidly progressive right hemisphere stroke in the setting of multiple infections that highlights the impact of comorbidities on stroke progression. We hope that reporting this case draws attention to the need for a multidisciplinary focus on the progression of stroke symptoms in the face of septic processes. A 60-year-old African American man with a past medical history of hypertension, diabetes, bilateral above-the-knee amputations, and frequent cocaine use presented to the hospital with left-sided deficits and suspected seizures. The patient’s presentation was complicated by a urinary tract infection (UTI), bladder outlet obstruction, pneumonia, and medication non-compliance. Computed tomography angiography (CTA) revealed severe stenosis of the cavernous segment of the right internal carotid artery (ICA). Magnetic resonance imaging (MRI) revealed a complete right hemisphere stroke with 19.28 mm midline shift. Criteria for brain death were met on day 6, and the patient died on day 10. This case highlights the rapid progression of infarction in the setting of critical internal carotid artery (ICA) stenosis, sepsis, and delayed urinary decompression. Early recognition and coordinated multidisciplinary care may improve outcomes in similarly complex presentations.