Deterioration following improvement with tPA therapy: Carotid thrombosis and reocclusion

Abstract
A 42-year-old, right-handed woman was seen 80 minutes after the acute onset of right hemiplegia, global aphasia, eye deviation to the left, and a right homonymous hemianopsia (NIHSS score 24). Her medial history included smoking, non–insulin-dependent diabetes mellitus, and peripheral vascular disease requiring bilateral femoral–popliteal bypasses. She had no history of cardiac or cerebral ischemia, and was not taking any antiplatelet treatment. A head CT scan showed a hyperdense left middle cerebral artery (MCA) and no hemorrhage.