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General Rehabilitation

Acute Limb Ischemia: A Case Report on Emergent Stroke Mimics during Inpatient Rehabilitation

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks
Has Audio

    Primary Author(s)

  • Harrison Jordan, DO

    Resident
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Greenville, North Carolina

    • Co-Author(s)

  • Kevin Chin, MD

    Resident
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Greenville, North Carolina

  • Ryan Jensen, DO

    Resident Physician
    East Carolina University Health
    Winterville, North Carolina

    • Poster Presenter(s)

  • Haris Shehzad, Other

    Medical Student
    Brody School of Medicine At East Carolina University
    Greenville, North Carolina

    • Co-Author(s)

  • RL

    Robert Lombard, MD

    Assistant Clinical Professor
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Grimesland, North Carolina

Disclosure(s):
Harrison Jordan, DO: No financial relationships to disclose
Kevin Chin, MD: No financial relationships to disclose
Ryan Jensen, DO: No financial relationships to disclose
Robert Lombard, MD: No financial relationships to disclose
Case Diagnosis: We present a case of a 77-year-old male admitted due to a cerebrovascular accident presenting with acute limb ischemia in the inpatient rehabilitation setting.

Case Description or Program Description: This patient with a history of atrial fibrillation on apixaban presented to the hospital with generalized weakness and altered mental status. Computed tomography (CT) of the head revealed right frontal intracerebral hemorrhage (ICH). Apixaban was held and the patient received tranexamic acid (TXA). During inpatient rehabilitation, the patient had difficulty moving the right lower extremity against gravity. On evaluation, the patient had full strength aside from flaccidity of right ankle dorsiflexion and plantarflexion. Of note, the patient’s right lower extremity had moderate temperature change and color difference. While acute limb ischemia was suspected, the patient was at high risk for a CVA. Evaluation via stroke team was completed, subsequently excluding acute intracranial abnormality. Vascular surgery was urgently consulted due to acute limb ischemia being high on the differential after an acute ischemic stroke and intracerebral hemorrhage had been excluded.

Setting: Inpatient Rehabiliation Center

Assessment/Results: Vascular surgery performed an urgent exploration in the operating room. The patient was found to have extensive thrombus of the superficial femoral arteries. Emergent thromboendarterectomy was performed and the patient experienced a full recovery.

Discussion (relevance): Strokes are a common pathology that affects patient populations of all ages and should remain high on the differential, especially for patients with a history of CVAs. Acute limb ischemia (ALI) is a sudden decrease in lower limb perfusion due to an acute occlusion. While acute inpatient rehabilitation often focuses on neurologic injury and recovery, this case highlights the importance of maintaining a wide differential when presenting symptoms may mimic acute neurologic injury.

Conclusions: Physician evaluation and careful consideration of a broad differential should be considered as signs of a stroke can mimic other medical conditions requiring urgent intervention.