The patient is brought to the angiography suite. A 4-vessel diagnostic angiogram is performed. Multifocal distal vascular stenoses, in both the anterior and posterior circulation, are identified. Intraarterial milrinone is administered in several proximal vessels, resulting in improvement in vascular caliber. Her dysarthria and weakness improve.
Her citalopram, while consistently set at a low dose for years, was discontinued after a risk/benefit discussion with the patient. She confirmed that she hasn't had any cannabinoid exposure. Initiation of verapamil was considered. However, given the lack of data showing that this affects outcomes, and her desire to avoid additional medications (especially as her headache has improved), this was deferred.
By day 3 of admission, her exam has remained stable. Magnesium gtt was stopped. She is transferred to the stroke unit, where she continues to receive treatment from PT, OT, and SLP. An MRI/MRA head/neck is obtained at this point given her clinical stability. An infarct within the left dorsolateral medulla is identified. There is mild multifocal vascular stenoses, much improved overall.
On day 5 of admission, she is discharged to inpatient rehab. After a week there, she is subsequently discharged back home.
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