A Case of Embolic Stroke with Oscillating Thrombus in the Internal Carotid Artery Associated with Antiphospholipid Antibody Syndrome and Complication by Systemic Sclerosis

Abstract

We report a 73-year-old woman with antiphospholipid antibody syndrome (APS) complication by systemic sclerosis. She was admitted to our hospital because of sudden onset of right hemiplegia and disturbance of consciousness. On admission, she had right hemiplegia, moderate disturbance of consciousness and global aphasia. Brain MRI and MRA showed high signal intensities in the anterior and posterior watershed areas on diffusion-weighted imaging (DWI) and left internal carotid artery (ICA) occlusion. Carotid ultrasonography (CU), B-mode scan performed on the following day demonstrated a thrombus oscillating with the cardiac cycle on the proximal site of the ICA. No other embolic sources were detected even by echocardiography. Our final diagnosis was embolic stroke with arterial thrombi accompanied by APS. After 6 weeks, CU showed that the thrombus was organized and immobilized. Embolic stroke with APS may be complicated by oscillating thrombus, and CU is thought to be useful for thrombus detection and follow-up.