The stroke seesaw: unveiling the enigma of stuttering acute ischemic stroke

Beyond the familiar face of the acute ischemic stroke, lies the unexpected display of symptoms challenging our preconceptions and beckoning us to explore the intriguing nuances that lie beneath the surface.

We introduce an unusual case of an older adult who presented to our institution with repetitive focal neurologic deficits (FND). Initial investigation was negative for any brain hemorrhage or infarcts. Repeat investigation during readmission showed findings of brain infarct for which appropriate treatment was provided. The fluctuating pattern of FND is what we refer to as a stuttering presentation of stroke.

Our case brings attention to stuttering, an atypical presentation of ischemic stroke, not previously well described in medical literature. Our case demonstrates that stuttering stroke presentations may imitate more short-lived neurologic events such as transient ischemic attacks.

All the patient events throughout the entirety of their time course should be thoroughly reviewed so that thrombolytics can then be considered in the earliest window of opportunity for patients with stuttering stroke presentations to prevent disability due to ischemic stroke.