A Fuzzy Determination of Stroke Onset
Teaching NeuroImages
Neurology
Resident & Fellow Section
© 2018 American Academy of Neurology
Vignette
• A 73-year-old gentleman with hypertension presented with left hemiparesis and left
hemineglect of unclear duration.
• Head CT and CTA of the head and neck showed subacute infarcts of the right frontal lobe and a right internal carotid artery thrombus, with
corresponding perfusion abnormalities that would have qualified him for thrombectomy (Figure).
J.E. Siegler, et al.
© 2018 American Academy of Neurology
Imaging
J.E. Siegler, et al.
© 2018 American Academy of Neurology
A Fuzzy Determination of Stroke Onset
• On closer examination of his face, it appeared that the facial hair on his left side was longer than his right.
• We deduced that he must have shaved his right side more recently than his left, and that he had neglected his left hemi-face.
• We estimated his stroke onset to be more than 24
hours prior to evaluation, thereby disqualifying him for thrombectomy.
• Subtle signs may help you to determine a stroke patient’s time last known normal.
J.E. Siegler, et al.
© 2018 American Academy of Neurology
