Rationale: Subcortical infarcts with TIA, multi-infarct dementias and vertebral artery stenosis are well-defined entities. Uniqueness of this case-report stems from the combination of vertebral artery narrowing, multiple subcortical infarcts and cortical atrophy without dementia, presenting with facial weakness. Elucidating the causality was the challenge in this case. Presenting concerns: A 45-year-old male executive complained of feeling unreal and difficulty in focusing while in office. Examination revealed normal cognition and a slight drooping of left lower face. Investigations and diagnoses: Brain MRI imaging revealed significant diffuse cortical atrophy, prominent lateral ventricles, multiple bilateral subcortical 3-4mm infarcts, periventricular ischemia and significant narrowing of right vertebral artery. A diagnosis of transient ischemic attack (TIA) was made. Intervention and outcome: The patient was admitted in ICU and put on statin and aspirin. Within 24 hours facial droop disappeared. One-week follow up revealed no neurological and cognitive deficit. Patient was advised to continue medication and modify his diet and lifestyle.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.