A case of acute right upper limb ischemia in a female aged 50 yrs presenting to ed

We present a case of a middle aged lady who presented to Emergency with acute onset severe 9/10 scale pain and numbness in right upper limb with no history of any previous morbidities. Myocardial infarction/acute cervical radiculopathy/CVA were being considered as working diagnosis after primary and secondary survey. An ECG done as P.O.C test showed AF with FVR. A detailed history at this stage revealed patient having received Injection Benzathine Penicillin for 5 years during her childhood but no other complaints suggesting rheumatic heart disease. Possibility of acute limb ischemia was suspected and an urgent color Doppler was ordered. This revealed total occlusion of proximal brachial artery. N.C.C.T brain was normal Consultation of CTVS surgeon taken who performed an emergency brachial artery embolectomy. Patient recovered well post operatively. But next morning patient showed signs of hemiparesis left side. MRI brain revealed MCA infarct right side.