Author: Priyanka Ramchandani, Riad Hosein, Vibhore Gupta / Editor: Sarah Edwards / Codes: NeuP5, NeuP9, SLO1, SLO2 / Published: 02/05/2025
A 61-year-old right-handed female presents to the emergency department (ED) with new sudden onset right sided sensory and motor deficits, particularly after gardening. 1 day ago, she was discharged with dual antiplatelets after being evaluated for dizziness, nausea, vomiting and right sided neck pain upon waking. She exhibited a significant difference of blood pressure in both her arms.
The patient has no history of blunt neck trauma or recent procedures causing hyperextension of her neck. Her pupils are equal and reactive. ECG showed sinus rhythm with normal troponin levels.
She is a non-smoker and has a past medical history of chronic kidney disease, gout, left sensorineural hearing Loss and vertigo. She has started to have increased frequency of sudden onset dizziness (each episode lasting 1 minute) in the recent past and is taking aspirin for left upper limb tingling that occurred a few years ago.