Clinical Reasoning: A 70-Year-Old Man With Systemic Illness Related Strokes Refractory to Medical Treatment Managed With Intracranial Stent

We present the case of a 70-year-old man with a history of embolic stroke, atrial fibrillation, deep vein thrombosis, and polymyalgia rheumatica who presented as a stroke code with transient right-sided focal neurologic deficits (motor and sensory), mild alteration in consciousness, and mild aphasia. His cerebrovascular imaging revealed new multifocal intracranial stenoses. Despite best medical management, this patient continued to have recurrent symptomatic cerebrovascular events. This case illustrates the evaluation approach and key differential diagnoses to consider in patients with stroke-like symptoms that fail to respond to best stroke medical management. Readers will be taught the importance of considering unusual stroke mechanisms in their initial evaluation of stroke codes and the intricate subtleties in medical and interventional management decisions.