Clinical Reasoning: A 71-Year-Old Man With Horizontal Gaze Palsy, Anarthria, and Quadriparesis

A 71-year-old right-handed male nonsmoker with type 2 diabetes, hypertension, and chronic lymphocytic leukemia (CLL) never requiring active treatment presented to the hospital with 1 week of subacute-onset nausea, vomiting, and unsteady gait. On examination, he was afebrile with blood pressure 155/82 mm Hg and heart rate 62 bpm. He had right hemiataxia with wide-based gait. CT head and CT angiogram resulted in ischemic stroke diagnosis with no vascular abnormalities. Cardiac workup was unremarkable. He was managed with antiplatelet therapy and risk factor optimization.

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