We describe the case of a 19-year-old woman with no significant medical history who developed progressive right-sided neck pain and palpitations one month following a pregnancy complicated by preeclampsia. Family history was significant for unprovoked deep vein thrombosis (DVT) and pulmonary embolism (PE) in her father at age 44. Systemic examination revealed mild swelling of the right upper extremity with pain on palpation. Computed tomography (CT) of the thorax with contrast demonstrated extensive occlusion of right upper extremity veins and collateralization of chest wall veins. Pulmonary emboli were present bilaterally in the segmental and subsegmental branches of the lower lobe pulmonary arteries. CT of the abdomen with contrast revealed thrombi in the left common and external iliac veins. Thrombophilia screening was normal. The patient was treated with enoxaparin and ampicillin/sulbactam. Her clinical condition improved, and she was discharged with an outpatient clinic follow-up appointment.

Background: A major limiting factor of favorable outcomes among patients with emergent large vessel occlusions (ELVO) is delay in transfer to a comprehensive stroke center (CSC). Stony Brook University Hospital (SBUH) is one of two CSCs in Suffolk County, serving approximately 1.5 million patients over 912 square miles. In 2019, SBUH implemented 2 mobile stroke units in strategic locations within Suffolk County to facilitate rapid delivery of acute stroke treatments. With the capability of performing computed tomography angiography (CTA) in addition to non-contrasted head CT, SBUH MSU offers an opportunity to rapidly triage patients to necessary CSCs. We sought to compare functional outcomes of patients receiving thrombectomies following transport by MSU versus conventional EMS and hospital transfers. Methods: A retrospective study was conducted that included patients eligible to receive mechanical thrombectomy from 2017 to 2020. Patients who had pre-morbid modified Rankin scale (mRs) greater than 0, transient ischemic events, subarachnoid hemorrhage, intraparenchymal hemorrhage, or strokes post-hospital arrival were excluded. A total of 77 patients were included, 37 of whom received care by MSU and 40 by EMS or transfers. Time interval from Door-to-Needle time was measured. T-test for independent samples was used to measure differences in time among both groups. Functional outcomes were measured using mRS at discharge. Patients were trichotomized into three outcome groups, mRS 0-1, 2-4, and 5-6. Chi square was used to analyze differences among the outcome groups Results: MSU patients had a significantly shorter Door-to-Needle time than the EMS patients: (69± 64 min vs. 115 ± 65 min respectively, t=3.319, 78.155df, P<0.001). At discharge in MSU group, 37.8% (14) had favorable mRS 0-1 compared to the control group 26.4% (14). The MSU group had 56.8% (21) moderate mRS 2-4 compared to the control group 47.2% (25) with mRS of 2-4. The MSU group had 5.4% (2) severe mRS 5-6 compared to the control group 26.4% (14). X 2 =7.716, 2df, p<.01 Conclusions: CTA can be performed on MSUs to detect ELVOs in the field and achieve prompt triage of these patients to CSCs, thereby reducing time to thrombectomy and improving short-term functional outcomes.

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