Abstract
A47-YEAR-OLD MAN presented with sudden onset of dysarthria and left-sided weaknesswhilepracticing golf on a driving range. His medical history was unremarkable. Onexamination,hewasdrowsy,had rightgazepreference,andshowedvisual and tactile extinction of the left stimuli. He also showed left central facialpalsyandlefthemiparesis.Diffusion-weighted magnetic resonance imaging of the brain showed infarctionsintheterritoryoftheright middlecerebralartery(Figure,Aand B).Cerebralangiographyrevealeddissection of the right internal carotid artery and occlusion of the right middlecerebralartery(Figure,Cand D). There was no underlying defect in the dissecting artery, and the patency of other cerebral arteries was normal. He underwent stentassisted angioplasty of the right internalcarotidarteryandsubsequent intraarterialurokinaseinjectioninthe rightmiddlecerebralartery.Remarkably,thepatientrecoveredwithonly mild dysarthria within a week and was discharged home with a prescribed regimen of aspirin (325 mg) and clopidogrel (Plavix, 75 mg).
Published Version
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