<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.2d1 20170631//EN" "JATS-journalpublishing1.dtd">
<ArticleSet>
<Article>
<Journal>
<PublisherName>jmedicalcasereports</PublisherName>
<JournalTitle>Frontiers in Medical Case Reports</JournalTitle>
<PISSN>I</PISSN>
<EISSN>S</EISSN>
<Volume-Issue>Volume 7; Issue 3</Volume-Issue>
<PartNumber/>
<IssueTopic>Multidisciplinary</IssueTopic>
<IssueLanguage>English</IssueLanguage>
<Season>(May-Jun, 2026)</Season>
<SpecialIssue>N</SpecialIssue>
<SupplementaryIssue>N</SupplementaryIssue>
<IssueOA>Y</IssueOA>
<PubDate>
<Year>-0001</Year>
<Month>11</Month>
<Day>30</Day>
</PubDate>
<ArticleType>Medical Case Reports</ArticleType>
<ArticleTitle>Acute Left Parietal and Occipital Cortical Infarcts Secondary to Severe Left Internal Carotid Artery Stenosis: A Case Report</ArticleTitle>
<SubTitle/>
<ArticleLanguage>English</ArticleLanguage>
<ArticleOA>Y</ArticleOA>
<FirstPage>1</FirstPage>
<LastPage>10</LastPage>
<AuthorList>
<Author>
<FirstName>Mayesha</FirstName>
<LastName>Ahmed</LastName>
<AuthorLanguage>English</AuthorLanguage>
<Affiliation/>
<CorrespondingAuthor>N</CorrespondingAuthor>
<ORCID/>
<FirstName>Madyson</FirstName>
<LastName>FitzGerald</LastName>
<AuthorLanguage>English</AuthorLanguage>
<Affiliation/>
<CorrespondingAuthor>Y</CorrespondingAuthor>
<ORCID/>
<FirstName>Abeera</FirstName>
<LastName>Rabbani</LastName>
<AuthorLanguage>English</AuthorLanguage>
<Affiliation/>
<CorrespondingAuthor>Y</CorrespondingAuthor>
<ORCID/>
<FirstName>Roxana</FirstName>
<LastName>Lazarescu</LastName>
<AuthorLanguage>English</AuthorLanguage>
<Affiliation/>
<CorrespondingAuthor>Y</CorrespondingAuthor>
<ORCID/>
</Author>
</AuthorList>
<DOI/>
<Abstract>Severe internal carotid artery (ICA) stenosis is an important and treatable cause of ischemic stroke, but diagnosis can be challenging when presentation is confounded by seizure activity and postictal neurological deficits. We report the case of a 77-year-old man with a history of prior cerebrovascular accidents, dementia, and seizure disorder who presented with multiple witnessed seizures followed by slurred speech, right facial droop, and right-sided weakness. Initial CT of the head showed only chronic ischemic changes, while CT angiography revealed severe (70__ampersandsignndash;99%) stenosis of the left cervical ICA. Because of active seizures and concern for Todd__ampersandsignrsquo;s paralysis, thrombolysis was deferred. EEG demonstrated epileptiform discharges over the left hemisphere, and although the patient showed rapid clinical improvement, MRI of the brain later revealed acute left parietal and occipital cortical infarcts with a subacute left corona radiata infarct. The infarct distribution was consistent with an artery-to-artery embolic pattern, and the ipsilateral high-grade ICA stenosis was considered the most likely contributing source, although a cardioembolic etiology could not be excluded in the setting of a known patent foramen ovale and multiple prior cerebrovascular events. The patient was managed medically with levetiracetam, dual antiplatelet therapy, and statin therapy, as he was not a candidate for carotid intervention given his advanced dementia and poor functional status. This case illustrates that acute ischemic stroke may coexist with postictal deficits and may be missed on initial imaging. In patients with high-grade carotid stenosis and a clinically ambiguous presentation, advanced neuroimaging and systematic etiologic evaluation are essential for accurate diagnosis and individualized management.</Abstract>
<AbstractLanguage>English</AbstractLanguage>
<Keywords>Ischemic Stroke,Internal Carotid Artery Stenosis,Large Vessel Atherosclerosis,Artery-To-Artery Embolism and Todd’s Paralysis</Keywords>
<URLs>
<Abstract>https://jmedicalcasereports.org/ubijournal-v1copy/journals/abstract.php?article_id=16249&title=Acute Left Parietal and Occipital Cortical Infarcts Secondary to Severe Left Internal Carotid Artery Stenosis: A Case Report</Abstract>
</URLs>
<References>
<ReferencesarticleTitle>References</ReferencesarticleTitle>
<ReferencesfirstPage>16</ReferencesfirstPage>
<ReferenceslastPage>19</ReferenceslastPage>
<References>Beghi E, Dand;#39;Alessandro R, Beretta S, Consoli D, Crespi V, Delaj L, Gandolfo C, Greco G, La Neve A, Manfredi M, Mattana F, Musolino R, Provinciali L, Santangelo M, Specchio LM, Zaccara G; Epistroke Group. Incidence and predictors of acute symptomatic seizures after stroke. Neurology 2011; 77: 1785-1793.
Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ; American College of Cardiology; American Stroke Association; American Association of Neurological Surgeons; American College of Radiology; American American College of Radiology; Society of NeuroInterventional Surgery; Society for Vascular Medicine; Society for Vascular Surgery. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Circulation 2011; 124: e54-130.
Campbell BCV, Khatri P. Stroke. Lancet 2020; 396: 129-142.
Caplan LR, Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol 1998; 55: 1475-1482.
Feldman AE, Gidal BE. QTc prolongation by antiepileptic drugs and the risk of torsade de pointes in patients with epilepsy. Epilepsy and; Behavior 2013; 26: 421-426.
Fisher RS, Engel JJ Jr. Definition of the postictal state: when does it start and end? Epilepsy Behav 2010;19: 100-104.
GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20: 795-820.
Hart RG, Diener HC, Coutts SB, Easton JD, Granger CB, Oand;#39;Donnell MJ, Sacco RL, Connolly SJ; Cryptogenic Stroke/ESUS International Working Group. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol 2014; 13: 429-438.
Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, Kamel H, Kernan WN, Kittner SJ, Leira EC, Lennon O, Meschia JF, Nguyen TN, Pollak PM, Santangeli P, Sharrief AZ, Smith SC Jr, Turan TN, Williams LS. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke 2021; 52: e364-e467.
North American Symptomatic Carotid Endarterectomy Trial Collaborators; Barnett HJM, Taylor DW, Haynes RB, Sackett DL, Peerless SJ, Ferguson GG, Fox AJ, Rankin RN, Hachinski VC, Wiebers DO, Eliasziw M. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991; 325: 445-453.
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2019; 50: e344-e418.
Saver JL, Carroll JD, Thaler DE, Smalling RW, MacDonald LA, Marks DS, Tirschwell DL; RESPECT Investigators. Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke. N Engl J Med 2017; 377: 1022-1032.</References>
</References>
</Journal>
</Article>
</ArticleSet>