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Case Report
Stroke like symptoms, radiation therapy induced atypical subclavian steal syndrome: Diagnosis and treatment
1 Resident PGY 3, Department of Neurology, UTMB, Galveston, USA
2 Fellow PGY 5, Department of Neurology, UTMB, Galveston, USA
3 Director of Diagnostic and Interventional Neuroradiology, Department of Radiology, UTMB, Galveston, USA
4 Chairman, Department of Neurology, UTMB, Galveston, USA
5 Director of Stroke Program, Department of Neurology, UTMB, Galveston, USA
Address correspondence to:
Ruiqing Sun
15410 Rocky Oak Ct, Houston, Texas 77059,
USA
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Article ID: 101040Z01RS2019
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Sun R, Rai P, Shah V, Raghuram K, Bhardwaj A, Kamel A. Stroke like symptoms, radiation therapy induced atypical subclavian steal syndrome: Diagnosis and treatment. Int J Case Rep Images 2019;10:101040Z01RS2019.ABSTRACT
Introduction: Radiation therapy induced subclavian stenosis can cause subclavian steal syndrome, which can present with posterior fossa stroke like symptoms. We present atypical subclavian steal syndrome, a stroke mimic induced by radiation therapy.
Case Report: A 63-year-old female with prior lung radiation therapy who presented with posterior circulation stroke like symptoms dizziness and unsteady gait. Patient had negative orthostatic vital signs, Hallpike maneuver, and head thrust test. Brain magnetic resonance imaging (MRI) and magnetic resonance angiogram (MRA) head were unremarkable. However, MRA neck demonstrated focal severe stenosis of the proximal left subclavian artery proximal to the origin of the left vertebral artery. The subclavian artery stenosis was further confirmed by a difference in blood pressure readings between bilateral extremities and absence of the left radial pulse. Patient was treated with left subclavian stent implantation resulting in restoration of antegrade flow in the left vertebral artery.
Conclusion: Subclavian stenosis should be considered in patient with history of chest/neck radiation therapy presenting with posterior circulation stroke like symptoms. Early diagnosis of subclavian steal syndrome is the prerequisite for timely treatment with antiplatelets and angioplasty/stent implantation to restore adequate perfusion.
Keywords: Radiation therapy, Stroke, Subclavian steal syndrome, Subclavian stent
SUPPORTING INFORMATION
Author Contributions
Ruiqing Sun - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Prashant Rai - Acquisition of data, Drafting the article, Final approval of the version to be published
Varun Shah - Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Karthikram Raghuram - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Anish Bhardwaj - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Adham Kamel - Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Ruiqing Sun et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
