A 62-year-old man, with no vascular risk factors or prior history of myocardial infarction, presented to the emergency department after experiencing a sudden collapse while driving. Neurological consultation was sought for a Glasgow coma scale of 9/15 and transient acute right hemiparesis 6 hours after the onset of his initial symptom. He scored 13 points on National Institute of Health stroke scale (maximum possible score of 42). His brachial systolic blood pressure was unequal: 90 mm Hg in the right arm and 120 mm Hg in the left arm. Imaging scans of brain (Figure A & B) and blood vessels (Figure C) were obtained.

A 62-year-old man, with no vascular risk factors or prior history of myocardial infarction, presented to the emergency department after experiencing a sudden collapse while driving. Neurological consultation was sought for a Glasgow coma scale of 9/15 and transient acute right hemiparesis 6 hours ...