• Stephanie R Falatko, Schmalz Philip G R PGR Department of Neurosurgery, University of Alabama Birmingham, Birmingham, Alabama, USA., and Mark Harrigan.
• Department of Neurosurgery, University of Alabama Birmingham, Birmingham, Alabama, USA. Electronic address: srfalatko@uabmc.edu.
• World Neurosurg. 2017 May 1; 101: 814.e15-814.e17.

BackgroundIschemic stroke recrudescence, or reappearance of previously resolved symptoms of ischemic stroke, may occur after physiologic stress. Although generally thought to be uncommon, this syndrome may account for a significant proportion of stroke mimics.Case DescriptionA 67-year-old man was admitted with a Hunt and Hess grade 2 spontaneous subarachnoid hemorrhage. He underwent digital subtraction cerebral angiography as part of imaging evaluation. About 30 minutes after the procedure, he developed dysarthria, right facial droop, and right pronator drift. The patient and family denied a history of similar symptoms or previous ischemic stroke. Brain magnetic resonance imaging demonstrated a remote left lacunar infarction. The symptoms resolved after 24 hours and were attributed to recrudescence of the patient's previous lacunar infarction. The physiological stress of the subarachnoid hemorrhage combined with the cerebral angiogram likely triggered the event.ConclusionsRecrudescence of symptoms of a previous stroke may be initiated by subarachnoid hemorrhage and/or a cerebral angiogram. The possibility of ischemic stroke recrudescence should be kept in mind as a possible stroke mimic.Copyright © 2017 Elsevier Inc. All rights reserved.

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