2015 Volume 38 Issue 4 Pages 256-261
A 61-year-old woman who presented with sudden dysarthria and left hemiplegia was admitted to our hospital. Brain MRI (diffusion-weighted image; DWI) showed high-intensity lesions from the right putamen to the corona radiata. Her symptoms improved within 2 hours, and the high-intensity lesions were not apparent on the brain MRI obtained 6 days after admission. Although warfarin therapy was started, she experienced a transient ischemic attack (TIA) again at 30 and 38 days after the first attack. Cilostazol was administered in addition to warfarin, but she experienced TIAs 22 and 26 days thereafter. Her therapy was changed from warfarin to cilostazol plus clopidogrel therapy, but she experienced a 6th episode of transient dysarthria and left hemiparesis 20 days later. Despite the addition of aspirin to cilostazol and clopidogrel, she experienced a last ischemic attack. The dysarthria and left hemiparesis (NIHSS 9) lasted for 72 hours, and slight left hemiparesis remained thereafter. MRI fluid-attenuated inversion recovery (FLAIR) image of the head revealed high-intensity lesions from the putamen to the corona radiata (3 slices). Blood examination, cerebrospinal fluid analysis, and gadolinium-enhanced brain MRI showed no evidence of demyelinating disease, cerebral vasculitis, or malignant brain tumor. She was diagnosed with branch atheromatous disease. This case had a characteristic course of repeated TIAs with reversible brain MRI lesions over a 3-month period.
