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Thrombus in the Brachiocephalic Trunk in Patient with Bovine Aortic Arch Variation Mimics a Stroke or Multiple Sclerosis

Case Report

Article Title: Thrombus in the Brachiocephalic Trunk in Patient with Bovine Aortic Arch Variation Mimics a Stroke or Multiple Sclerosis

Author: Maria Cholakova*, Nikolay Mihnev and Ivan Staikov

Published Date: October 20, 2023

DOI: 10.26717/BJSTR.2023.53.008396

Abstract:

Embolism is mostly associated with arterial rather than venous injury, and with neuronal infarction rather than waste of myelin. Multiple sclerosis (MS) is an autoimmune inflammatory disease of the central nervous system (CNS) with difficult differential diagnosis. MS and stroke have general risk factors. The immune mechanisms of stroke are similar to neurodegenerative diseases and are adjunct to neuroinflammation. In autoimmune diseases the inflammation could increase risk for stroke or amplify the effect of conventional stroke risk factors. In the present case, the young patient was with clinical features susceptible for demyelinating disease. After performed MRI, cerebrospinal fluid examination, evoked potentials and screening for thrombophilia, multiple sclerosis was excluded. Ultrasound doppler examination and computed tomography (CT) angiography was performed because of the acute complaints of numbness and pain in right hand. It was found complete occlusion of the proximal half of the right ulnar artery, occlusion of the distal part of radial artery with its branches forming the superficial and deep palmar arches. The patient was diagnosed with parenchymal thrombus in brachiocephalic trunk, involving more than 80% of its lumen. When there is clinical presentation of relapses with neurological symptoms typical for MS in the differential diagnoses a vascular embolization should be considered and screening for thrombophilia could be useful. Multiple sclerosis could have difficult differential diagnose and a couple of new trials and experimental models show the significance of PAI-1 in etiology of neuroinflammation and neurodegeneration in multiple sclerosis, as well as a risk factor for thrombotic events in young adults.

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