Sep. 12, 2021
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A 51-year-old man was evaluated for transient quadriparesis and dysarthria. At the time of examination, the patient was clinically asymptomatic but had a history much like the one described in C. Miller Fisher’s classic observation on the “herald-hemiparesis” as prodrome of basilar artery thrombosis (Fisher 1988). Diffusion-weighted MRI showed no acute lesion. MRA demonstrated moderate to severe midbasilar artery stenosis. Catheter cerebral angiography showed a 65% to 70% midbasilar stenosis with poststenotic dilatation above the level of the anterior inferior cerebellar artery and below the labyrinthine arteries. (Contributed by Dr. José Biller.)