Patient with Subclavian Steal Syndrome Associated with Acute Cerebral Syndrome

We report a 58- year-old man with personality change, cognitive deterioration and vertigo that gradually progressed over a two-week period. He was diagnosed with subclavian steal syndrome with complete reversal of the blood fl ow in the left vertebral artery and the difference in the blood pressure between the arms of 45mmHg. During the hospitalization, systolic blood pressure in his left arm was kept over 130mmHg using saline infusions, which lead to the patient’s prompt recovery. As other potential causes of acute cerebral syndrome were ruled out, we speculated on subclavian steal as a possible etiological factor. One possibility was thalamic cognitive syndrome. Th e other, in our opinion more likely, was that posterior circulation insuffi ciency compensated from the anterior circulation over the circle of Willis, leading to anterior circulation deficiency which clinically presented as acute cerebral syndrome. The slight increase in the systolic blood pressure enhanced the collateral circulation and resulted in a complete recovery. If the patient remained asymptomatic during the further follow-up, and complied with a dietary regimen with higher saline and fluid intake, endovascular treatment would not be necessary. Th is pathophysiological mechanism and the therapeutic approach might make this case unique, since no such cases have been reported in the literature.