Fleeting Monoparesis and Aortic Arch Atheroma

A 72-year-old female with a history of hypertension and hyperlipidemia presented with alternating numbness, tingling sensations and weakness of both upper extremities with left shoulder pain. Each episode of these symptoms lasted about thirty minutes and reoccurred three times on either side of her upper limbs at about 2 hourly intervals. She had no associated headache, blurry vision, slurred speech or diplopia. Six years prior to presentation, she underwent a successful repair of an unruptured abdominal aortic aneurysm. Significant findings include; blood pressure of 177/74-mm Hg and a radial pulse rate of 78 beats per minute, blood urea nitrogen (BUN) of 21, creatinine, and abnormal lipid profile. Head CT was negative. Chest x-ray showed calcification and tortuosity of the thoracic aorta. A trans-thoracic echo was negative for vegetation while trans-esophageal echocardiogram (TEE) showed a tortuous thoracic aorta and an ulcerative plaque with an overlying four-cm irregular mobile thrombus in the aortic arch and several small mobile clots. The patient treated with aspirin, heparin and placed on warfarin for one year at target I.N.R of 2.0-3.0. She was symptom free at one-year follow-up.