A 68 year old man presents with vertigo, dysphagia, dysarthria, and an unbalanced gait for 12 hours; these symptoms were abrupt in onset. His medical and surgical histories are unremarkable. He smokes heavily, but only drinks socially.
The CT scan of the brain appears normal.
The ECG is significant for Q-waves in leads II, III and AvF. Serial ECGs show no dynamic changes.
The MRI reveals an infarction of the lateral aspect of the right medulla.
The echocardiogram reveals the presence of inferior wall hypokinesis. There are no structural or valvular abnormalities; no cardiac source of emboli is seen. The ejection fraction is 62%.