A 60-year-old male with a history of diabetes mellitus, tobacco use, and hypertension presented with a chief complaint of transient right-handed clumsiness and slurred speech. There was a three-day history of headache, nausea, vomiting, and falls. Medications on admission included insulin, furosemide, and fosinopril. His white blood cell count (WBC) was 12.5 x 109/L with a predominance of segmented neutrophils, but absent left shift. A chemistry panel and urinalysis were unremarkable.
Initial neurological examination was non-focal and head CT was normal. Carotid ultrasound showed up to 70% stenosis of both the left and right internal carotid arteries. An admission diagnosis of transient ischemic attack was made and acetylsalicylic acid was given. There was a progressive decline in neurological function with dysarthria, ataxia, delirium, and lethargy. A diagnostic lumbar puncture was…
