Acute Ischemic Stroke

A 62-year-old right-handed male with a history of hypertension (on lisinopril) presented with acute left-sided weakness. He was seen in his usual state of health at 8 am. His wife heard a noise at 10 am. He was unable to stand up and could not move his left side. Family brought him to the local emergency department 3 h after symptom onset. During assessment, he had left hemiparesis, left facial droop, dysarthria, left hemi-neglect, and right gaze preference. He did not have any evidence of aphasia. His National Institute of Health Stroke Scale (NIHSS) was 12. Computerized tomography (CT) scan of head showed no hemorrhage. Computerized tomography angiography (CTA) of head showed an abrupt cutoff at the onset of anterior division of right middle cerebral artery (commonly referred as right anterior M2 branch). CTA neck showed about 80% stenosis of right internal carotid artery (ICA).