Ischemic Stroke due to Intracranial Embolization of a Pelvic Phlebolith in a Pregnant Patient Successfully Treated by Surgical Embolectomy following Attempted Endovascular Thrombectomy

Figure 3

(a–d) CTA perfusion was obtained approximately 14 hours following presentation, following delivery by cesarean section. Perfusion maps demonstrate reduced blood flow (a) and reduced mean transit time (b) in the right MCA territory. Initial MRI (c) obtained within 3 hours following presentation demonstrates a focus of diffusion restriction in the right basal ganglia and corona radiata, measuring up to 4 cm compatible with core ischemic infarct. Postprocedure MRI (d), obtained after attempted thrombectomy and surgical endarterectomy, approximately 48 hours from the prior MRI, demonstrates stable 4 cm core infarct with sparing of the majority of the at-risk territory.