An Indian patient, 44 years old, hypertensive without treatment for 10 years, occasional smoker, who rose in the morning prior to admission with weakness in the right hemibody, as well as loss of pulse in the emergency department x 165 mm Hg was found that the right heart failure.
Neurological examination showed hypoesthesia in the maxillary branch of the right trigeminal nerve as the only objective disorder of sensitivity.
Muscle strength and tone were preserved at all levels, but osteotendinous hyperreflexia was found in the right hemibody with ipsilateral Babinski.
Elements of cerebellar dysfunction were evidenced when dysdiadochokinesia, dysmetria and dysphonia mobilized the right limbs.
Walking was impossible due to the tendency to fall to the right when trying to do it without support.
Blood analysis showed hemoglobin, differential leukocyte and electrolyte count within normal limits.
Hyperlipidemia due to an increase in total cholesterol (7.42 mm/1) was observed.
Electrocardiogram and transthoracic echocardiogram were normal.
Magnetic resonance imaging (MRI) identified an area of subacute ischemic infarction comprising the left lenticular nucleus and internal capsule.
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Treatment consisted of antiplatelet agents, statins and physiotherapy.
The patient was discharged one week later with evident improvement.
