Dysarthria and severe hemiparesis

Clinical history A 67-year-old woman presented with an acute onset of dysarthria and severe left-sided hemiparesis. She was admitted to our stroke unit and systemic thrombolysis was administered three hours after onset of symptoms. She recovered promptly with only a slight left-sided facial palsy remaining. Her general history was unrevealing except for arterial hypertension and elevated blood cholesterol. Examination Neurological scores: On admission: NIHSS 11, Barthel 20, mRS 5; After thrombolysis: NIHSS 2, Barthel 100, mRS 1; On discharge: NIHSS 1, Barthel 100, mRS 1. Special studies While a dense-media sign was visible on CT before thrombolysis, extra-and intracranial Doppler and duplex sonography as well as MRA after thrombolysis did not show any relevant stenosis or occlusion. DWI showed acute ischemic stroke affecting the right lenticular nucleus, as well as the head and body of the caudate nucleus (Figure 7.1). ECG monitoring and echocardiography failed to identify a cardiogenic source of embolism.