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A 65-year-old woman with chronic atrial fibrillation was admitted for an elective exchange of an implanted defibrillator for idiopathic dilated cardiomyopathy. To facilitate this procedure, warfarin was withheld for 5 days. Before the procedure was performed, acute-onset right hemiparesis and expressive dysphasia developed. Urgent noncontrast computed tomography (CT) of the brain and CT angiography of the intracranial and extracranial arterial circulation confirmed an acute occlusion of the M2 segment of the middle cerebral artery, which was consistent with the presence of an embolus (Panel A, arrow). Ninety-five minutes after the onset of neurologic deficits, the patient was given a bolus . . . [Full Text of this Article] |
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