Case 213 -- Left Internal Carotid Artery Thrombosis

Contributed by Malini Srinivasan MD and Franklin A. Bontempo MD
Published on line in November1999


PATIENT HISTORY:

A 36 years old male presented to the emergency department in an altered state of consciousness. The drug and alcohol screens were negative. MRI of the brain revealed a left basal ganglia infarct. CT scan with contrast revealed a short segment of thrombus at the origin of the left internal carotid artery. EEG revealed focal slowing in the left hemisphere.

LABORATORY VALUES:

Laboratory tests to rule out a hypercoagulable state revealed the following:


       Factor V Leiden mutation    NEGATIVE
       Factor II (prothrombin) 20210 A variant    NEGATIVE

       Antithrombin III-A    105    80 - 120 %N
       Protein C    124    70 - 140 %N
       Protein S    101    60 - 145 %N
       Plasminogen    115    80 - 150 %N
       Antiplasmin    105    80 - 120 %N

LUPUS ANTICOAGULANT PROFILE:

           VALUES    REFERENCE RANGE
       Prothrombin time    12.6 seconds    11.5 - 15 seconds
       International normalized ratio    0.9     -
       APTT    37.2 seconds    26 - 36 seconds
       APTT mix    37 seconds    26 - 36 seconds
       Thrombin time    19.4 seconds    16 - 23 seconds
       Fibrinogen    345 mg/dl    160 - 460 mg/dl
       Factor X    0.91 U/ml    0.60 - 1.40 U/ml
       Factor VIII    1.85 sec    0.5 - 1.5 U/ml
       HEX LIP    POSITIVE    NEGATIVE
       DRVV ratio    1.0    0.7 - 1.1
       TTI (1:50)    1.1    0.9 - 1.5
       TTI (1:500)    1.2    0.9 - 1.5
       ACA IgG    6.6 GPL    0 - 23 GPL
       ACA IgM    2.4 MPL    0 - 11 MPL

APTT: Activated partial thromboplastin time; DRRV: dilute Russell viper venom ratio; HEX LIP: Hexagonal lipid neutralization test; TTI: Tissue thromboplastin inhibition index; ACA: Anticardiolipin antibody.


FINAL DIAGNOSIS


Case 

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