A strangled wife

Abstract

neurointerventional unit for cervical and cerebral angiography. She had been seen at another hospital 3 weeks earlier with sudden onset of weakness of her left arm. She had been treated for hypertension and hyperthyroidism. Upon arrival she was awake, alert, and oriented, with normal cognition and speech. The function of her cranial nerves was intact with no signs of Horner’s syndrome. Motor examination showed left pronator drift, decreased left hand and arm strength, and poor rapid finger movements. Sensory examination was normal to all modalities. Auscultation revealed a carotid bruit on the left side. A computed tomograph scan showed right middle frontal and opercular gyrus infarcts (figure, A). Carotid angiography showed bilateral symmetrical stenoses of the internal carotid arteries at the level of C2–C3 (figure, B, C). There was no evidence of atherosclerosis. A filling defect suggestive of an embolus was shown in the ascending frontal branch of the right middle cerebral artery. Renal angiography showed no evidence of fibromuscular dysplasia. The angiographic appearances of the carotid lesions were consistent with healed spontaneous or traumatic carotid dissections.