Recurrent Ischemic Strokes in the Territory of Recurrent Artery of Heubner Presenting in Relation to Facial Swelling and Weakness

Abstract

Strokes involving the Recurrent Artery of Huebner are quite rare and are often asymptomatic. Here, we describe a rare case of recurrent infarctions involving the right Recurrent Artery of Heubner, likely due to small vessel disease. Our 32-year-old patient presented to the emergency department with sudden onset right-sided facial weakness, numbness, and difficulty with eye closure. A non-contrast head computed tomography scan and magnetic resonance imaging revealed an incidental subacute infarct in the territory of the right Recurrent Artery of Heubner. He was discharged on valacyclovir and prednisone for suspected Bell’s palsy, as well as aspirin, atorvastatin, metformin, and antihypertensives for secondary stroke prevention. Unfortunately, he was noncompliant with medications and lost to follow-up until he presented again more than one year later with a complaint of isolated right facial swelling and ipsilateral weakness. Imaging revealed an incidental new subacute infarct in the territory of the right Recurrent Artery of Heubner. Close follow-up of the patient and guidelines for appropriate management of secondary risk factors are discussed.