Description
A 71-year-old Caucasian female patient presented with acute onset of visual disturbance, gait difficulties and fluctuation of consciousness.
Her medical history included artery hypertension, previous cardiac valve replacement with mechanical prosthesis, in treatment with oral anticoagulant.
An emergency CT scan resulted negative for acute lesions, haematological exams were normal, international normalised ratio (INR) was >2.5. The EKG revealed high-frequency atrial fibrillation, not previously known.
At the neurological examination, the patient presented drowsiness, easily resolved by verbal stimulus, bilateral divergent diplopia, with eye movements possible only horizontally and severe postural instability with retropulsion.
On the day after the onset of neurological symptoms, the patient underwent brain MRI without gadolinium. Axial fluid attenuation inversion recovery (FLAIR) sequences revealed diffuse cerebral vasculopathy in the bilateral white matter without evidence of acute lesions (figure 1). Diffusion-weighted imaging (DWI) sequences revealed the presence of recent ischaemic lesions in the territory of the artery...
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