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.

中文翻译：

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临床推理： 一名 70 岁男性患有全身性疾病相关卒中，对颅内支架治疗的药物治疗无效。


我们介绍了一名 70 岁男性的病例，有栓塞性卒中、心房颤动、深静脉血栓形成和风湿性多肌痛病史，表现为卒中代码，伴有短暂的右侧局灶性神经功能缺损（运动和感觉）、轻度意识改变和轻度失语症。他的脑血管成像显示新的多灶性颅内狭窄。尽管进行了最好的药物治疗，但该患者仍继续出现复发性的症状性脑血管事件。本病例说明了对最佳卒中药物治疗无反应的卒中样症状患者应考虑的评估方法和关键鉴别诊断。读者将了解在初步评估中风代码时考虑不寻常的中风机制的重要性，以及医疗和介入管理决策中错综复杂的微妙之处。