A 66 Year Old Woman with Recurrent Stroke

Recurrent strokes involving various arterial territories can carry a broad differential diagnosis. Multiple progressive infarcts in a patient with clinical signs and symptoms out of proportion to their infarct pattern on imaging should compel the clinician to broaden the differential to include inflammatory causes of stroke also. A stepwise approach, using clinical, imaging and laboratory clues to direct further invasive testing is required for proper diagnosis and management in such cases. We present the case of a 66 year old woman with recurrent strokes over the span of a few weeks with deficits and mental status changes out of proportion to her infarcts on MRI brain and an inflammatory CSF. Since commencement of treatment for the underlying inflammatory cause of her strokes, she has remained stroke free for over two years in follow up.