Embolic Stroke Due to a Mural Thrombus in the Ascending Aorta Following Cisplatin-based Chemotherapy

Figures

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  Figure 1.. Computed tomography (CT) of the chest before and after cisplatin-based chemotherapy. Contrast chest CT prior to chemotherapy (A) shows the lung cancer in the right middle lobe (white arrowhead). Non-contrast chest CT immediately after the final chemoradiotherapy course (B) shows that the tumor in the right middle lobe has completely vanished. R indicates right side A through B.

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  Figure 2.. Magnetic resonance imaging of the brain on day 1. Note the acute brain infarction in the left middle cerebral artery (MCA) territory, showing a high signal intensity on diffusion-weighted imaging (A, B) and low signal intensity on apparent diffusion coefficient maps (C, D). The ischemic area does not show obvious signal changes on fluid-attenuated inversion recovery, except for the left insula cortex (E, F). Magnetic resonance angiography indicates non-terminal occlusion of the left internal carotid artery and probable main trunk occlusion of the left MCA (G, H). R indicates right side A through H.

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  Figure 3.. Contrast-enhanced magnetic resonance imaging of the brain before chemotherapy. Contrast-enhanced T1-weighted coronal (A) and axial (B) images show that the left internal carotid (black arrow) and middle cerebral (white arrow) arteries appear to be normal. R indicates right side A through B.

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  Figure 4.. Magnetic resonance imaging of the brain on day 2. Note the acute brain infarction in the anterior territory of the left middle cerebral artery (MCA), showing a high signal intensity on diffusion-weighted imaging (A, B) and low signal intensity on apparent diffusion coefficient maps (C, D). The ischemic lesion also exhibits a high signal intensity on fluid-attenuated inversion recovery (E, F). Magnetic resonance angiography indicates complete occlusion of the left internal carotid artery and the left MCA, but cross flow through anterior communicating artery supplies the left anterior cerebral artery (G, H). R indicates right side A through H.

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  Figure 5.. Computed tomography (CT) of the brain, neck and chest. Contrast neck CT on day 4 (A) shows the massive thrombus in the left internal carotid artery (white arrow). Contrast chest CT on day 4 (B, C) demonstrates the aortic mural thrombus (black arrow) attached to the calcified lesion of the ascending aorta (white arrowhead). There is no mural thrombus in the ascending aorta on contrast chest CT examined before chemotherapy (D). Brain CT on day 8 (E) displays hemorrhagic infarction in the left middle cerebral artery territory. Contrast chest CT on day 17 (F) shows the disappearance of the aortic mural thrombus. R indicates right side A through F.

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  Figure 6.. Magnetic resonance imaging at 12 months after stroke. T2-weighted images (A, B) show old infarction in the left middle cerebral artery (MCA) territory. Magnetic resonance angiography shows occlusions of the left internal carotid artery and the left MCA (C, D). R indicates right side A through D.