Thread 1/n #POCUS as a mystery solving tool. M/50, SYNCOPE. Seemed benign orthostatic, and I was upset a Head CT was done. Was expecting it normal, but surprise - reported as left parietal WATERSHED territory infarct. MRI later shows infarct better -
2/n Re-examined carefully, and indeed patient had a homonymous right inferior quadrant-anopia. But WHY does he have watershed infarct unilaterally, from what is a global hypo-perfusion event? Left carotid looks ok...
3/n left carotid doppler -
4/n Why not look at Transcranial Doppler of MCA's while at it? L-MCA peak velocity ~30 cm/s - as compared to R-MCA peak velocity ~70 cm/s .
5/5 Later MR Arteriography confirmed a L-MCA stenosis. Most likely, due to pre-existing stenosis, this patient sustained a unilateral watershed territory infarct in a transient global hypo-perfusion event (syncope).
Share this Scrolly Tale with your friends.
A Scrolly Tale is a new way to read Twitter threads with a more visually immersive experience.
Discover more beautiful Scrolly Tales like this.