Bilateral MCA Stroke—A Rare Presentation Successfully Treated with Mechanical Thrombectomy

Background: Bilateral MCA stroke is a very rare pathology, accounting for less than 1% of stroke presentations. Unless treated, the natural course of the disease leads to significant morbidity and mortality if not treated.

Case: A 75-year-old female patient presented with sudden onset left hemiparesis, facial palsy and dysarthria for 1.5 hours. Her NIHSS score at the time of presentation was 9. NCCT head was performed which showed no acute infarct and bleed. CT perfusion was performed and it showed area of perfusion mismatch in right MCA territory. CTA showed distal M2 occlusion. Intravenous tPA was initiated and there was clinical improvement. After 35 minutes, she had 1 episode of seizure. On examination, patient developed right side weakness with global aphasia. Repeat stroke imaging was performed. There was perfusion deficit in bilateral MCA territory (left > right). Mechanical thrombectomy was done for left MCA occlusion. Right MCA clot was recanalized and small residual perfusion deficit distally.

Discussion: Acute bilateral occlusion of both MCAs is usually due to cardiac disease, such as AF although dissection, cardiac embolism, and atherothrombosis are other possible causes. In our case, patient initially demonstrated left-sided symptoms, which then became bilateral.

Publication History

Article published online:
09 February 2023