This patient noticed
that her left arm went "limp." It lasted about 20 minutes, then
things were fine. She drove herself to the emergency room where
they thought she might be having a heart attack. When cardiac testing
showed no problems, she was sent home. The next day she noticed
"numbness" in two fingers that lasted a bit longer but
resolved completely. The third day she again complained of numbness
in the same two fingers, and was admitted to the hospital. She got
worse, with problems involving her face, her enunciation of words
("I lisped"), and her left arm. Auscultation
of her neck revealed a carotid bruit.
Right carotid stenosis, greater than 70%, was confirmed by ultrasound
and cerebral arteriography.
It was also found that she had developed significant external to
internal carotid blood flow through anastomoses of these vessels
around her right eye. She was treated surgically (a carotid endarterectomy)
and given antihypertensive medications, a statin agent, and a daily
aspirin. She has had no further problems.