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Case report
peer-reviewed

Acute Brachial Artery Occlusion in an Elderly Patient With Acute Myocardial Ischemia



Abstract

We present a case of left upper extremity paresis secondary to acute brachial artery occlusion in an elderly female with active non-ST segment elevation myocardial ischemia (NSTEMI) in the setting of paroxysmal atrial fibrillation. The patient was initially suspected to have a cerebrovascular attack (CVA); however, computed tomography (CT) head was negative for acute stroke. The diagnosis was confirmed by computed tomographic angiography (CTA) of the upper extremity, confirming the diagnosis of acute left brachial artery occlusion. In evaluating a patient with concern for acute stroke with atypical presentation, it is essential to obtain a complete history and perform a rapid and thorough examination. Acute limb ischemia (ALI) should be considered in the differential diagnosis of CVA with atypical presentation.



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Case report
peer-reviewed

Acute Brachial Artery Occlusion in an Elderly Patient With Acute Myocardial Ischemia


Author Information

Gabriel O. Ologun Corresponding Author

General Surgery, Guthrie Clinic/Robert Packer Hospital

Christian Bohan

Medical Student, Geisinger Commonwealth School of Medicine

Tiffany Lau

General Surgery, Guthrie Clinic/Robert Packer Hospital

Mohammad Sultany

General Surgery, Guthrie Clinic/Robert Packer Hospital

Andrew Trecartin

General Surgery, Guthrie Clinic/Robert Packer Hospital

Zachary Wolfe

Internal Medicine, Guthrie Clinic/Robert Packer Hospital

Silviu Marica

Vascular Surgery, Guthrie Clinic/Robert Packer Hospital

Lawrence Sampson

Vascular Surgery, Guthrie Clinic/Robert Packer Hospital

Umashankar Ballehaninna

Vascular Surgery, Guthrie Clinic/Robert Packer Hospital


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Acknowledgements

Burt Cagir, Paul Granet, and Lihau-N'kanza for their support and assistance in writing the manuscript


Case report
peer-reviewed

Acute Brachial Artery Occlusion in an Elderly Patient With Acute Myocardial Ischemia


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Case report
peer-reviewed

Acute Brachial Artery Occlusion in an Elderly Patient With Acute Myocardial Ischemia

Gabriel O. Ologun">Gabriel O. Ologun , Christian Bohan">Christian Bohan, Tiffany Lau">Tiffany Lau, Mohammad Sultany">Mohammad Sultany, Andrew Trecartin">Andrew Trecartin, Zachary Wolfe">Zachary Wolfe, Silviu Marica">Silviu Marica, Lawrence Sampson">Lawrence Sampson, Umashankar Ballehaninna">Umashankar Ballehaninna

  • Author Information
    Gabriel O. Ologun Corresponding Author

    General Surgery, Guthrie Clinic/Robert Packer Hospital

    Christian Bohan

    Medical Student, Geisinger Commonwealth School of Medicine

    Tiffany Lau

    General Surgery, Guthrie Clinic/Robert Packer Hospital

    Mohammad Sultany

    General Surgery, Guthrie Clinic/Robert Packer Hospital

    Andrew Trecartin

    General Surgery, Guthrie Clinic/Robert Packer Hospital

    Zachary Wolfe

    Internal Medicine, Guthrie Clinic/Robert Packer Hospital

    Silviu Marica

    Vascular Surgery, Guthrie Clinic/Robert Packer Hospital

    Lawrence Sampson

    Vascular Surgery, Guthrie Clinic/Robert Packer Hospital

    Umashankar Ballehaninna

    Vascular Surgery, Guthrie Clinic/Robert Packer Hospital


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements

    Burt Cagir, Paul Granet, and Lihau-N'kanza for their support and assistance in writing the manuscript


    Article Information

    Published: September 19, 2017

    DOI

    10.7759/cureus.1700

    Cite this article as:

    Ologun G O, Bohan C, Lau T, et al. (September 19, 2017) Acute Brachial Artery Occlusion in an Elderly Patient With Acute Myocardial Ischemia. Cureus 9(9): e1700. doi:10.7759/cureus.1700

    Publication history

    Received by Cureus: August 14, 2017
    Peer review began: August 22, 2017
    Peer review concluded: September 01, 2017
    Published: September 19, 2017

    Copyright

    © Copyright 2017
    Ologun et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

We present a case of left upper extremity paresis secondary to acute brachial artery occlusion in an elderly female with active non-ST segment elevation myocardial ischemia (NSTEMI) in the setting of paroxysmal atrial fibrillation. The patient was initially suspected to have a cerebrovascular attack (CVA); however, computed tomography (CT) head was negative for acute stroke. The diagnosis was confirmed by computed tomographic angiography (CTA) of the upper extremity, confirming the diagnosis of acute left brachial artery occlusion. In evaluating a patient with concern for acute stroke with atypical presentation, it is essential to obtain a complete history and perform a rapid and thorough examination. Acute limb ischemia (ALI) should be considered in the differential diagnosis of CVA with atypical presentation.



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Gabriel O. Ologun, M.D.

General Surgery, Guthrie Clinic/Robert Packer Hospital

For correspondence:
gabe.ologun@gmail.com

Christian Bohan

Medical Student, Geisinger Commonwealth School of Medicine

Tiffany Lau

General Surgery, Guthrie Clinic/Robert Packer Hospital

Mohammad Sultany

General Surgery, Guthrie Clinic/Robert Packer Hospital

Andrew Trecartin

General Surgery, Guthrie Clinic/Robert Packer Hospital

Zachary Wolfe

Internal Medicine, Guthrie Clinic/Robert Packer Hospital

Silviu Marica

Vascular Surgery, Guthrie Clinic/Robert Packer Hospital

Lawrence Sampson

Vascular Surgery, Guthrie Clinic/Robert Packer Hospital

Umashankar Ballehaninna

Vascular Surgery, Guthrie Clinic/Robert Packer Hospital

Gabriel O. Ologun, M.D.

General Surgery, Guthrie Clinic/Robert Packer Hospital

For correspondence:
gabe.ologun@gmail.com

Christian Bohan

Medical Student, Geisinger Commonwealth School of Medicine

Tiffany Lau

General Surgery, Guthrie Clinic/Robert Packer Hospital

Mohammad Sultany

General Surgery, Guthrie Clinic/Robert Packer Hospital

Andrew Trecartin

General Surgery, Guthrie Clinic/Robert Packer Hospital

Zachary Wolfe

Internal Medicine, Guthrie Clinic/Robert Packer Hospital

Silviu Marica

Vascular Surgery, Guthrie Clinic/Robert Packer Hospital

Lawrence Sampson

Vascular Surgery, Guthrie Clinic/Robert Packer Hospital

Umashankar Ballehaninna

Vascular Surgery, Guthrie Clinic/Robert Packer Hospital