Posterior Circulation Stroke with Neck Neoplasia in A Hypertensive Patient

Abstract

Posterior circulation strokes account for 20-25% of ischemic events, frequently presenting with altered sensorium, dysphagia, and limb weakness that challenge early recognition. Coexisting spinal pathology further complicates diagnosis, mandating comprehensive neuroimaging. A 68-year-old female with hypertension (amlodipine 5 mg daily) presented with a 15-day history of progressive altered sensorium, drowsiness, anorexia, dysphagia, and bilateral lower limb weakness. Initial vitals showed BP 130/80 mmHg, PR 74 bpm, SpO₂ 98% on room air. Serial assessments revealed evolving tachycardia (PR 106-116 bpm), desaturation (SpO₂ 90-98%), and hypertension (up to 160/100 mmHg). Laboratory findings included leukocytosis (WBC 17,450/mm³, neutrophils 90%), elevated CRP (13.4 mg/L), and mild hypokalemia (K⁺ 3.3 mEq/L). CSF analysis demonstrated elevated protein (157.4 mg/dL) with lymphocytic pleocytosis (40 cells/mm³). MRI brain confirmed acute posterior circulation infarction with DWI hyperintensities, while cervical spine imaging revealed a neoplastic lesion causing neural compression. Provisional diagnoses included posterior circulation stroke, neoplasia-related cervical dystonia, systemic infection, and hypertension. Management comprised intravenous antibiotics (ceftriaxone 1 g BD, piperacillin-tazobactam 4.5 g TDS, metronidazole), methylprednisolone 1 g daily, aspirin 75 mg, atorvastatin 40 mg, amlodipine 2.5 mg, and supportive therapy (pantoprazole, ondansetron, IV fluids, lactulose). Clinical improvement ensued with vital sign stabilization and resolving neurological deficits. Timely MRI-guided diagnosis and aggressive multimodal therapy yielded favorable short-term outcomes, underscoring integrated neurological care for elderly patients with multifocal crises.