Acute Brachial Artery Occlusion in an Elderly Patient With Acute Myocardial Ischemia

Abstract

We present a case of left upper extremity paresis secondary to acute brachial artery occlusion in an elderly female with active non-ST segment elevation myocardial ischemia (NSTEMI) in the setting of paroxysmal atrial fibrillation. The patient was initially suspected to have a cerebrovascular attack (CVA); however, computed tomography (CT) head was negative for acute stroke. The diagnosis was confirmed by computed tomographic angiography (CTA) of the upper extremity, confirming the diagnosis of acute left brachial artery occlusion. In evaluating a patient with concern for acute stroke with atypical presentation, it is essential to obtain a complete history and perform a rapid and thorough examination. Acute limb ischemia (ALI) should be considered in the differential diagnosis of CVA with atypical presentation.

Acute Brachial Artery Occlusion on Point-of-Care Ultrasound in the Emergency Department: A Case Report

“…3,4 Several studies have identified upper extremity arterial occlusions after coronary catheterization; however, there are few reports of unprovoked brachial artery occlusion. 1,5,6 When considering brachial artery occlusion in patients, the diagnostic workup should include a thorough physical exam, point-of-care ultrasound (POCUS), and coagulation laboratory studies. 7 A computed tomography (CT) angiogram Creighton University School of Medicine, Department of Emergency Medicine, Phoenix, Arizona Mayo Clinic, Department of Emergency Medicine, Phoenix, Arizona * † can be considered if POCUS and clinical exam are insufficient to provide this time-sensitive diagnosis.…”

“…Acute limb ischemia affects approximately 10–14 patients per 100,000 annually and more commonly occurs in the lower extremities. 1 , 2 The brachial artery is located in the upper extremities and is commonly used to measure blood pressure. Acute embolization of the brachial artery is most commonly cardiac in origin.…”

“… 3 , 4 Several studies have identified upper extremity arterial occlusions after coronary catheterization; however, there are few reports of unprovoked brachial artery occlusion. 1 , 5 , 6 …”