A 25-year-old right-handed woman presented with sudden-onset aphasia and right hemiparesis. She was restless, and her GCS score was E4V1M5 on admission. Diffusion-weighted MRI showed high intensity areas in the left insular cortex, frontal lobe, and corona radiata. Perfusion CT showed a large hypoperfusion area almost identical to the left MCA distribution. Cerebral angiography disclosed occlusion of the left internal carotid artery bifurcation. Emergency superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis was performed.
She showed progressive recovery in verbal function following surgery, and reached a GCS score of E4V4M6 at Day 3. Postoperative perfusion CT confirmed restoration of cerebral blood flow in the left MCA distribution. She became ambulatory with a cane 2 months later.
In spite of thorough examination, the cause of the internal carotid artery occlusion remains unclear. STA-MCA anastomosis in the acute stage may be beneficial in neurological recovery in a selected group of patients with intracranial internal carotid artery occlusion.