Chandril Chugh, Khushbu Goel, Himanshu Agarwal, Mukesh Kumar and Mukherji JD
Large vessel occlusions account nearly half of all the ischemic strokes. Recognition of a large vessel stroke is paramount in early and effective stroke treatment as these patients carry poor prognosis if not treated in time. Clinical exam is the single most important tool to diagnose a patient with stroke and initiate further diagnostic studies for optimal management. We present a case of a 72 years old woman who presented with acute onset confusion without any focal motor deficits or cranial nerve findings and went on to have occlusion of the right middle cerebral artery. This patient underwent mechanical thrombectomy and recovered completely during her hospital stay. This case highlights that even large vessel occlusions can present with only confusion as a presenting symptom. Such patients are at a risk of not being diagnosed as acute stroke and rather managed conservatively for acute delirium. As is evident in our case, a potential devastating stroke was prevented with timely vascular imaging and neurointervention.
