Some Embolic
strokes of undetermined origin (ESUS) are extremely rare. That is the case of a
patient with multiple vascular risk factors who presented with persistent
inability to get up after a fall at home. Physical examination revealed only
mild left-sided claudication. Magnetic resonance imaging showed multiple
paramedian emboli in both cerebral hemispheres, with normal cardiac tests
(echocardiogram; Holter ECG).
Finally, a CT
angiogram revealed a high grade stenosis of an azygos anterior cerebral artery.
The patient had a prothrombotic state due to poorly controlled vascular risk
factors and very low vitamin B12 levels.
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