Severe neurological consequences of subclavian steal in the setting of cardiogenic shock.

To cite: Hefton S, Bogush N, Crawford RS, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2015210274 DESCRIPTION Awoman in her 70s was found lying prone, with an ST-elevation myocardial infarction and in cardiogenic shock. She was obtunded, answering ‘No’ to all questions, and was observed to have anisocoria with a pinpoint right pupil, 5 mm left pupil, decreased right corneal reflex and nystagmus. Head CT scan was unremarkable, but CTangiogram of the chest demonstrated an occluded left subclavian with reconstitution proximal to the left vertebral artery origin (figure 1 and video 1). Her neurological deficits were thought to be attributable to reduced cardiac perfusion of a cerebral circulation made tenuous by subclavian steal physiology. Subclavian steal syndrome occurs when proximal stenosis or occlusion of the subclavian artery