Clinical case
This is the case of a 50 years old hypertensive for 5 years on
amlodipine 10 mg. She was admitted with consciousness disturbance with a
right hemiplegia. The exact time of beginning of the symptoms was
unknown. The patient was found unconscious. On admission, the
neurological examination showed a Glasgow scale at 9/15, a right
hemiplegia with Babinky sign, associated with anesthesia and a left
third nerve palsy (Figure1) and the initial NIHSS (National Institutes
of Health Stroke Scale) score was 20. Blood pressure was 145/90 mmHg and
capillary blood glucose 1.15g/l. The brain CT showed a bilateral
thalamic and mesencephalic infarction (figure 2 and 3), the MRI was not
done because it was not available. CT angiogram of supra aortic arteries
showed an occlusion of the V4 portion of the left vertebral artery
(figure 4). Selective cerebral angiography to make the diagnosis was not
performed. The electrocardiogram and echocardiogram were normal but
Holter-electrocardiogram wasn’t done. The blood count, urea, creatinine,
lipid profile and blood glucose were normal. She was treated with 100 mg
of aspirin, statins. The evolution was marked by the occurrence of an
aspiration pneumopathy at day 4 of hospitalization. This was
successfully treated with amoxicillin and clavulanic acid. At 10 days of
hospitalisation, the consciousness problems had regressed. On discharge,
she retained hemiplegia, motor aphasia and third nerve damage. Her NIHSS
score was 16. However, follow-up was not performed because the patient
was lost to follow-up.