Impaired consciousness and unilateral limb movement due to acute limb ischemia complicated by acute cerebral infarction A case report

Rationale: The symptoms of impaired consciousness and unilateral motor impairments are a perfect scenario for cerebral infarction, and a physician can easily miss the findings of limb ischemia on the patient paralyzed side even if acute limb ischemia (ALI) occurs on that side. The purpose of this case report is to reiterate the need to suspect ALI in patients with impaired consciousness who cannot complain of symptoms such as abnormal limb paresthesia or pain. Patient concerns: An 89-year-old woman with impaired consciousness and motor impairment of the left upper and lower extremities was transported to our hospital. Diagnoses: Brain magnetic resonance imaging showed a suspected cerebral infarction in the posterior circulation; contrast-enhanced computed tomography showed occlusion of the left axillary artery and left femoral artery; and ultrasonography showed occlusion of the right popliteal artery. Interventions: Cerebral angiography was performed simultaneously with surgical thrombectomy to treat the ALI. Mechanical thrombectomy was not performed for cerebral infarction. Outcomes: Although motor impairment of the left upper and lower extremities persisted, the patient successfully underwent limb salvage. Lessons: Both cerebral infarction and ALI require early diagnosis and treatment. This rare case of cerebral infarction complicated by ALI emphasizes the need to avoid missing the signs of ALI in patients with impaired consciousness.