J Cerebrovasc Endovasc Neurosurg.  2013 Sep;15(3):221-224. 10.7461/jcen.2013.15.3.221.

Distal Subclavian Artery Occlusion Causing Multiple Cerebral Infarcts Consequence of Retrograde Flow of a Thrombus?

• Baek JH
• Shin DH
• Kang CK
• Lee YB

• KMID: 1491442
• DOI: http://doi.org/10.7461/jcen.2013.15.3.221

Abstract

Intracranial embolization usually arises from the heart, a vertebrobasilar artery, a carotid artery, or the aorta, but rarely from the distal subclavian artery upstream of an embolus. We report on a patient who experienced left shoulder and forearm pain with weak blood pressure and pulse followed by concurrent onset of left hemiplegia. This case is a rare example of multiple cerebral embolic infarctions, which developed as a complication of distal subclavian artery thrombosis possibly associated with protein S deficiency.

Keyword

Subclavian artery; Protein S deficiency; Thoracic outlet syndrome; Retrograde cerebral infarction

MeSH Terms

Aorta
Arteries
Blood Pressure
Carotid Arteries
Embolism
Forearm
Heart
Hemiplegia
Humans
Infarction
Protein S Deficiency
Shoulder
Subclavian Artery
Thoracic Outlet Syndrome
Thrombosis

Figure

• 

  Fig. 1 High signal intensities are observed in the left posterior cerebral artery territory, right thalamus, right medial temporal lobe, and right cerebellum on fluid attenuated inversion recovery (FLAIR) images (white arrow). Mild stenosis is observed at the right posterior cerebral artery and right proximal internal carotid artery, which was probably not the cause of the infarction (white arrowhead).

• 

  Fig. 2 Brachial computed tomography angiogram shows contrast-filling defects caused by embolic occlusions in the left axillary and brachial arteries (white arrow).

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