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A 62-year-old woman presents to the emergency room (ER) with the chief complaint of left facial numbness.
She describes the sudden onset of left facial numbness associated with "dizziness," which she further characterizes as mild lightheadedness but not true vertigo. These symptoms lasted approximately 15-20 minutes and completely resolved. She denies associated chest pain, palpitations, headache, nausea/vomiting, focal weakness, other focal numbness, speech/visual disturbance, or other neurologic symptoms. She has a history of hypertension, and her only current medications are an angiotensin-converting enzyme inhibitor and a beta-blocker. She does not take aspirin and has no history of similar events, migraine headaches, coronary artery disease, cardiac arrhythmia, or other pertinent medical history.
Other than mild systolic hypertension (150/80), her vital signs and general examination are unremarkable. Her neurologic examination is likewise unremarkable: cranial nerves are intact with no facial asymmetry or sensory deficit; strength and reflexes are normal and symmetric, with bilateral flexor plantar response; primary/cortical sensory modalities are intact; and coordination/gait are intact without truncal or appendicular dystaxia.
Upon arrival to the ER, the patient underwent head computed tomography without contrast, which was unremarkable. She subsequently had magnetic resonance imaging (MRI) scan of the brain, performed approximately 30 hours after the onset of symptoms, which was interpreted by the neuroradiologist as "unremarkable for age."
This patient's MR images in the following figures were obtained on a 1.5-Tesla scanner and include axial T1-weighted, T2-weighted, fluid attenuated inversion recovery (FLAIR), diffusion weighted imaging (DWI), and apparent diffusion coefficient (ADC) map images. Postcontrast (gadodiamide) T1-weighted images in the axial and coronal planes were obtained, and there was no pathologic contrast enhancement. For simplicity, routine T1-weighted and T2-weighted images are referred to as T1 or T2.
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