Recrudescence of Symptoms of Remote Ischemic Stroke After a Cerebral Angiogram.

Abstract

Ischemic stroke recrudescence, or reappearance of previously resolved symptoms of ischemic stroke, may occur after physiologic stress. Although generally thought to be uncommon, this syndrome may account for a significant proportion of stroke mimics. A 67-year-old man was admitted with a Hunt and Hess grade 2 spontaneous subarachnoid hemorrhage. He underwent digital subtraction cerebral angiography as part of imaging evaluation. About 30 minutes after the procedure, he developed dysarthria, right facial droop, and right pronator drift. The patient and family denied a history of similar symptoms or previous ischemic stroke. Brain magnetic resonance imaging demonstrated a remote left lacunar infarction. The symptoms resolved after 24 hours and were attributed to recrudescence of the patient's previous lacunar infarction. The physiological stress of the subarachnoid hemorrhage combined with the cerebral angiogram likely triggered the event. Recrudescence of symptoms of a previous stroke may be initiated by subarachnoid hemorrhage and/or a cerebral angiogram. The possibility of ischemic stroke recrudescence should be kept in mind as a possible stroke mimic.