Acute bilateral internal carotid artery (ICA) occlusion has rarely been reported to exhibit an improvement in prognosis. Herein, we report a case of acute bilateral ICA occlusion presenting with bilateral symmetrical cortical and basal-ganglia infarctions that exhibited dramatic improvement after a mechanical thrombectomy.
The patient was a 72-year-old man with a history of hypertension who presented with a coma and quadriplegia during sleep and experienced moderate vomiting and diarrhea the day before admission to our hospital. Neurological examination revealed that the patient was in a coma (NIHSS 35). A brain computed tomography (CT) scan showed a hypodense lesion in the bilateral frontal cortex. An emergency cerebral angiography demonstrated complete occlusion of the bilateral ICA. Subsequently, a mechanical thrombectomy of the bilateral ICA was successfully performed. At a three-month follow-up, the patient had residual slight aphasia and quadriparesis (NIHSS 16).
Bilateral ICA occlusion should be considered if a patient presents with a coma, quadriplegia, and symmetrical cortical infarctions. In such a case, a bilateral mechanical thrombectomy may represent a potential treatment for improving the prognosis of the affected patient.

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