Young Patient With Headache and Amaurosis Fugax

A 48-year-old male farmer with a past medical history of nonspecific headache experienced acute onset of throbbing headache centered over his forehead. About an hour later he acutely lost sight in his right eye, lasting for ≈5 minutes. When the severe headache continued, the patient’s wife called an ambulance. In the ambulance, he received fentanyl for the headache but was otherwise normal. At the primary hospital an internist investigated the patient and the vision was found to be normal and no neurological deficit was detected. The patient received some more painkillers for presumed migraine. An hour later, the patient developed left-sided hemiparesis and he became slightly drowsy. Computed tomographic (CT) scan of the head revealed a hyperdense middle cerebral artery sign on the right. The patient was then transferred to a tertiary care center where a neurologist obtained a National Institutes of Health Stroke Scale of 11 (age wrong, left hand and foot drifted into the bed during 10/5 seconds, visual and tactile neglect, partial gaze deviation, sensory deficit in the left hand, and deficit in the left visual field). There were no contraindications for thrombolysis and the patient received the bolus of thrombolysis treatment 2 hours and 50 minutes from the development of hemiparesis. After the bolus administration, the patient underwent perfusion CT and CT angiography. The latter showed occlusion of the …