Moni Roy, MD, FACP
(Photo : Moni Roy, MD, FACP)

In the realm of medical advancements, while extraordinary cases often grab headlines, it is crucial to recognize the remarkable breakthroughs occurring in medicine that may go unnoticed. This case study sheds light on the experience of a 72-year-old Caucasian male patient who presented with a history of recurrent transient ischemic attacks and various neurological symptoms. Originally admitted to a different hospital, the patient was subsequently transferred due to right-sided facial drooping and difficulty speaking.

During his hospital stay, the patient initially demonstrated improvement in his right-sided weakness. However, on the third day, a sudden deterioration in his condition prompted a stroke alert. Diagnostic imaging in the form of a head and neck computed tomography angiography (CTA) revealed a significant narrowing (stenosis) of the proximal left internal carotid artery, along with the presence of a free-floating thrombus (FFT) within the artery. Notably, a calcified atheromatous plaque was also observed in the same area.

Upon arrival at the neurology intensive care unit, the patient's treatment commenced with the administration of a heparin drip. Collaborative discussions involving a multidisciplinary team comprising experts from neurosurgery, vascular surgery, and the patient's family were held to determine the most suitable approach. Dr. Moni Roy, an esteemed specialist in rare diseases within the realm of hospital medicine, including uncommon presentations of common diseases, played a pivotal role in the patient's care.

It is important to highlight that FFT is an exceptionally rare occurrence, with an incidence rate of only 0.05% based on a retrospective study utilizing ultrasonography for carotid artery imaging. Consequently, documented cases of FFT are infrequent and limited within the medical literature.

After thorough consultations with the neurosurgery and vascular surgery services, alongside extensive deliberations involving the patient and his family, a decision was made to pursue a medical management strategy. This approach involved the simultaneous use of anticoagulation and antiplatelet therapy. Specifically, the patient was prescribed Aspirin and Warfarin, with the aim of maintaining an international normalized ration (INR) target range of 2-3.

Dr. Roy's research proved instrumental in guiding the medical management plan, providing compelling evidence supporting the utilization of a heparin drip followed by Coumadin and Aspirin. Research findings further substantiated the notion that immediate surgical intervention may not always be necessary, as FFT can be effectively addressed through medical treatment.

Subsequently, the patient was transferred to an inpatient stroke rehabilitation unit, where he underwent a comprehensive three-week program comprising occupational and physical therapy. The primary objective of this rehabilitation was to facilitate recovery and restore optimal motor function. Following the completion of the program, the patient exhibited satisfactory progress and was safely discharged home.

To ensure ongoing anticoagulation and mitigate the risk of future complications, the patient's long-term treatment plan incorporated a combination of Aspirin and Warfarin. This regimen aimed to maintain appropriate blood thinning levels and minimize the likelihood of recurrent events. During the subsequent six-month follow-up period, the patient displayed no recurrence of neurological deficits and showcased positive residual motor function, indicating a favorable outcome resulting from the implemented treatment and rehabilitation interventions.

Given its significant contributions to the successful treatment of FFT, this noteworthy case study has garnered citations across various scholarly publications. Through their collective expertise, Dr. Moni Roy, Dr. Ashish Kumar Roy, Dr. Jeffrey R. DeSanto, and Dr. Murad Abdelsalam have paved the way for advancements in medical treatment and have enhanced the care provided to patients facing similar challenges.

The invaluable contributions of Dr. Moni Roy, Dr. Ashish Kumar Roy, Dr. Jeffrey R. DeSanto, and Dr. Murad Abdelsalam cannot be overstated. Their expertise, dedication, and collaborative spirit have elevated the quality of this study and have left a lasting impact on the medical community's understanding of rare diseases and neurology.

Moni Roy's Publications

Dr. Roy has published numerous papers on her medical research, focusing on infectious diseases and the rare presentations of common diseases. One notable contribution is her research on free-floating thrombus in the carotid artery, which led to development of a treatment protocol to prevent strokes. (Roy, M., Roy, A. K., DeSanto, J. R., & Abdelsalam, M. (2016). Free Floating Thrombus in Carotid Artery in a Patient with Recurrent Strokes. Paper presented at the American College of Physicians Downstate meeting, November 2016.)

Her work has been cited by the Journal of NeuroInterventional Surgery, highlighting the impact and significance of her research in rare diseases. (Fitzpatrick et al., Expanding the role of stent-retriever endovascular thrombectomy: a case series of free-floating thrombus. Journal of NeuroInterventional Surgery, neurintsurg-2018-013946) Importantly, her research demonstrated the efficacy of medical management for free-floating thrombus, eliminating the need for surgical intervention.

Dr. Moni Roy has exhibited a steadfast commitment to patient care, education, and professional development throughout her career. Her diverse experiences, from serving as a Senior Medical Officer in India to engaging in clinical observerships and private practice, have enriched her understanding of healthcare and enabled her to provide comprehensive and compassionate care to her patients.

About the Author

Christie Carey is an accomplished writer with a focus on medical research and a dedication to enhancing healthcare understanding.