A patient suffering from acute left subclavian artery thrombosis presented with an unusual syndrome of prominent somnolence, right cerebellar signs, and left upper extremity ischemia. Clinical, angiologic, and electrophysiologic stud ies confirmed a brain stem and reticular formation dysfunction due to vertebro basilar ischemia. Urgent thromboembolectomy led to neurologic improvement and satisfactory revascularization of the involved upper limb.
Get full access to this article
View all access options for this article.
References
1.
Williams SJ: Chronic upper extremity ischemia: Current concepts in management. In: The Surgical Clinics of North America, 1st ed., ed. by Persson AV.Philadelphia: W.B. Saunders Company, 1986, pp. 355-375.
Barner HB, Peterson GJ: Carotid-subclavian bypass graft. In: Mastery of Surgery, ed. by Nyhus LM, Baker RJ.Boston: Little, Brown and Company, 1984, pp. 1318-1322.
4.
Goldenberg E. , Arlazoroff A., Pajewski M., et al.: Unusual clinical signs in left subclavian artery occlusions: Clinical and angiographic correlation. Stroke14(3):396-398, 1983.
5.
Moruzzi G., Magoun HW: Brain stem reticular formation and activation of the EEG. Electroencephalogr Clin Neurophysiol1:455-473, 1949.
6.
Jasper HM, Proctor LD, Knighton RS, et al (eds.): Reticular Formation of the Brain. Boston : Little, Brown and Co.1958.
7.
Plum F., Posner JB: The Diagnosis of Stupor and Coma, 3rd ed. Philadelphia: Davis, 1982.
8.
Markand ON, Dyken ML: Sleep abnormalities in patients with brain stem lesions. Neurology26:769-776, 1976.
9.
Stockard JJ, Rossiter VS: Clinical and pathologic correlations of brain stem auditory response abnormalities . Neurology27:316-325, 1977.
10.
Kaji R., McCormick F., Kameyama M. and Carpel CL: Brain stem auditory evoked potentials in early dignosis of basilar artery occlusion. Neurology35:240-243, 1985.
