• Jun Sato, Tsukasa Yagi, Yusuke Ishii, Rei Hinoura, Ryuta Kajimoto, Tsukasa Kuwana, Nobutaka Chiba, Takeshi Saito, and Kosaku Kinoshita.
• Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan.
• Medicine (Baltimore). 2023 Oct 27; 102 (43): e35657e35657.

RationaleThe symptoms of impaired consciousness and unilateral motor impairments are a perfect scenario for cerebral infarction, and a physician can easily miss the findings of limb ischemia on the patient paralyzed side even if acute limb ischemia (ALI) occurs on that side. The purpose of this case report is to reiterate the need to suspect ALI in patients with impaired consciousness who cannot complain of symptoms such as abnormal limb paresthesia or pain.Patient ConcernsAn 89-year-old woman with impaired consciousness and motor impairment of the left upper and lower extremities was transported to our hospital.DiagnosesBrain magnetic resonance imaging showed a suspected cerebral infarction in the posterior circulation; contrast-enhanced computed tomography showed occlusion of the left axillary artery and left femoral artery; and ultrasonography showed occlusion of the right popliteal artery.InterventionsCerebral angiography was performed simultaneously with surgical thrombectomy to treat the ALI. Mechanical thrombectomy was not performed for cerebral infarction.OutcomesAlthough motor impairment of the left upper and lower extremities persisted, the patient successfully underwent limb salvage.LessonsBoth cerebral infarction and ALI require early diagnosis and treatment. This rare case of cerebral infarction complicated by ALI emphasizes the need to avoid missing the signs of ALI in patients with impaired consciousness.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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