Clinical reasoning: a case of progressive cognitive decline reversed by middle cerebral artery stent placement.

SECTION 1 A 46-year-old right-handed African American man presented to the emergency department after a 10minute episode of sudden-onset left-hand weakness and slurred speech. His medical history was significant for a left cerebellar stroke 6 years ago. That event occurred during a physical training exercise and was thought to be secondary to a vertebral artery dissection.1,2 He was placed on aspirin 81 mg daily. The patient had minimal residual deficits, with left face numbness and left hypoacusis. He did not smoke, drink, or use recreational drugs. There was no family history of stroke or vascular disease. On initial examination, the patient was normotensive. His mental status was intact, with a MiniMental State Examination (MMSE) score of 30/30. Figure 1 Initial imaging