Clinical reasoning: a case of progressive cognitive decline reversed by middle cerebral artery stent placement
| Autor: | Sarah Tartar, Gary Spiegel, Michael Rosario, Louise D. McCullough |
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| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Middle Cerebral Artery Cranial nerve examination Vertebral artery Constriction Pathologic Left ventricular hypertrophy Resident and Fellow Section Internal medicine medicine.artery medicine Humans Cognitive decline Papilledema Stroke medicine.diagnostic_test Brain Middle Aged medicine.disease Anesthesia Angiography Middle cerebral artery Cardiology Stents Neurology (clinical) medicine.symptom Psychology Cognition Disorders |
| Zdroj: | Neurology. 76(12) |
| ISSN: | 1526-632X |
| Popis: | A 46-year-old right-handed African American man presented to the emergency department after a 10-minute episode of sudden-onset left-hand weakness and slurred speech. His medical history was significant for a left cerebellar stroke 6 years ago. That event occurred during a physical training exercise and was thought to be secondary to a vertebral artery dissection.1,2 He was placed on aspirin 81 mg daily. The patient had minimal residual deficits, with left face numbness and left hypoacusis. He did not smoke, drink, or use recreational drugs. There was no family history of stroke or vascular disease. On initial examination, the patient was normotensive. His mental status was intact, with a Mini-Mental State Examination (MMSE) score of 30/30. There was no apraxia, aphasia, or visual field deficit. Cranial nerve examination had normal results with the exception of left hypoacusis and left facial numbness over the V1–V3 distribution to pinprick. Funduscopic examination revealed no papilledema or vasculopathy. Motor, sensory, and cerebellar examinations were normal. Deep tendon reflexes were 2+ throughout with bilateral plantar responses. Laboratory testing including a complete blood count, serum chemistry, coagulation panel, and liver function tests were normal. EKG showed normal sinus rhythm and no evidence of left ventricular hypertrophy. MRI showed no evidence of acute intracranial abnormalities; a chronic left cerebellar infarct was seen (figure 1). CT angiography demonstrated severe bilateral middle cerebral artery (MCA) stenosis, worse on the right, as well as an absent left vertebral artery which was confirmed by conventional angiography (figure 2A). Figure 1 Initial imaging Noncontrast head CT (A) on admission demonstrating chronic left cerebellar infarct. Fluid-attenuated inversion recovery (FLAIR) MRI on admission shows no evidence of ischemic changes in the middle cerebral artery territory (B). FLAIR was also negative (C). Figure 2 Initial cerebral angiogram Angiogram on admission (A), at time of cognitive decline (B), and poststent placement (C) … |
| Databáze: | OpenAIRE |
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