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.