Clinical Reasoning: A 66-year-old man with recurrent multi-territory infarcts

A 66-year-old man was referred to our center for evaluation of recurrent infarcts in multiple vascular territories over the preceding 6 months (figure 1). The patient first presented with a 3-month, stuttering course of transient neurologic deficits, including right arm and leg hemiparesis, expressive aphasia, and right homonymous hemianopia. He was initially evaluated at a community Stroke Prevention Clinic. His medical history was significant for several classic vascular risk factors: coronary artery disease requiring a coronary artery bypass graft, dyslipidemia for which he was taking atorvastatin 20 mg daily, and obstructive sleep apnea with noncompliance to his continuous positive airway pressure mask. In addition, he had atrial fibrillation for which he had undergone a cardiac ablation procedure 2 years prior. He was a nonsmoker and was normotensive. He had a distant history of left nephrectomy for biopsy-proven renal cell carcinoma, with several subsequent normal abdominal ultrasounds.
Source: Neurology - Category: Neurology Authors: Tags: All Cerebrovascular disease/Stroke, All Education RESIDENT AND FELLOW SECTION Source Type: research