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Posterior cerebral artery embolism: hemianopsia and median longitudinal fasciculus syndrome

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Abstract

MUCH can be learned from acute neurologic signs even though pathologic correlation cannot be obtained. Stroke syndromes when carefully observed from the beginning are often of real diagnostic help. The case we are reporting demonstrates the value of attention to neurologic details in determining the localization and etiology of central nervous system malfunction.

Report of a case

A 57-year-old man was admitted to the Cleveland Clinic Hospital on January 27, 1970, because of fever. During the previous seven years he had chest pain intermittently. Three years before admission to the hospital he apparently had an acute myocardial infarction in the anterior wall, and one year later a ventricular aneurysm was found. The patient remained reasonably well until the last month when fever developed and persisted despite antibiotic treatment.

At physical examination the patient’s temperature was 101 F, pulse rate 95, and the blood pressure 130 mm Hg systolic, and 80 mm Hg diastolic. He appeared lethargic and confused. His skin was dry and the conjunctivae were injected. The cardiac impulse was paradoxic; a grade II holosystolic murmur was heard over the apex, and a pericardial rub was also present. Percussion and auscultation of the lungs disclosed no abnormalities; the abdomen was soft; the liver and spleen were not enlarged. The clinical impression was ventricular aneurysm with pericarditis, and probable subacute bacterial endocarditis.

The hemoglobin was 12.6 g per 100 ml, and the leukocyte count was 17,300 per cubic millimeter, with 86 percent neutrophils. An electrocardiogram demonstrated a healed infarction in . . .


 

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