Abstract
An 80-year-old woman with hypertension and dyslipidemia was admitted because of consciousness disturbance. She also had right upper limb paresis, right facial palsy, and dysarthria. Normocytic normochromic anemia was observed in the initial blood examination. Bilateral multiple high intense lesions in the cortex and subcortex including watershed area were also observed in the initial magnetic resonance imaging (MRI) diffusion-weighted image, but there was no significant stenosis or occlusion in the extracranial or intracranial cerebral arteries. She had a black stool before admission, and a gastric ulcer of A1 stage without active bleeding was shown in the gastroendoscopy. At first, she underwent erythrocyte transfusion for anemia, and neurological symptom rapidly improved. An anticoagulant treatment with heparin was started after confirmation of no bleeding in the gastroendoscopy examination. Global cerebral hypoperfusion and anemic hypoxia were possible etiologies of her brain infarction despite the lack of significant stenosis or occlusion of the cerebral arteries. Transesophageal echocardiography revealed a severe aortic arch atheroma and aortogenic brain embolism was also a possible etiology. Neither neurological deterioration nor recurrence of stroke was observed during the hospital days and she was discharged home on foot.
