Case description

A 39-year-old woman presented to the emergency department with decreased consciousness. One hour before, she had headache. She had an active SARS-CoV-2 infection and a history of anaemia from uterine fibroids. On examination, she was somnolent with a Glasgow Coma Scale score of 6 out of 15. There was a bilateral vertical gaze palsy with a left-sided oculomotor nerve palsy. The remaining neurological examination was normal. The initial suspected diagnosis was of subarachnoid haemorrhage. However, CT scan of head and CT cerebral angiogram were normal. Her cerebral CT perfusion imaging was reported as normal at first visual evaluation and by automated software analysis. However, on closer inspection of different perfusion maps, there were small perfusion deficits bilaterally in the medial thalamus and in the left paramedian midbrain (figure 1A). We, therefore, suspected an acute ischaemic …