A rare consequence of malignant hypertension

摘要

A 41-year old bike-instructor was admitted to hospital with sudden-onset occipital headache, left-sided 'numbness' and dysphagia upon awakening. On admission, his blood pressure (BP) was 250/154 mmHg. Examination revealed a right Homer's syndrome, right-sided ataxia, reduced sensation to pain and temperature on the right face and left upper and lower limbs. Computed tomography (CT) brain was normal but subsequent magnetic resonance imaging (MRI) revealed an acute infarction of the right lateral medulla oblongata (panel A, arrow). The combination of this finding and the patient's presenting features were consistent with a diagnosis of lateral medullary syndrome. Magnetic resonance angiography (MRA) of the neck demonstrated high signal areas along the wall of the distal right vertebral artery (panel B). Further imaging with computed tomography angiography (CTA) demonstrated a double lumen sign in the right vertebral artery.