BMJ Case Reports 2017; doi:10.1136/bcr-2016-218358
  • Reminder of important clinical lesson

The cause of the stroke: a diagnostic uncertainty

  1. Ava Jackson2
  1. 1Stroke Medicine, Barts Health NHS Trust, London, UK
  2. 2Stroke and Geriatric Medicine, Barts Health NHS Trust, London, UK
  1. Correspondence to Dr Abhishek Dattani, a.dattani07{at}
  • Accepted 6 June 2017
  • Published 23 June 2017


A 39-year-old man with a history of sickle cell disease (SCD) presented with left leg weakness. He had a normal CT head and CT angiogram, but MRI head showed multiple acute bilateral cortical infarcts including in the right precentral gyrus. The MRI findings were more in keeping with an embolic source rather than stroke related to SCD, although it could not be ruled out. He also had an echocardiogram which revealed a patent foramen ovale. He was treated with antiplatelet therapy and also had red blood cell exchange transfusion. His symptoms improved significantly and he was discharged with follow-up as an outpatient and a cardiology review.


  • Contributors Both AD and AJ were involved with the conception and drafting of the article, revising it for important changes and providing final approval for the publication of the article. They both agree to be accountable for the article.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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