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Dear Editor, We report a case of a patient that was diagnosed as having a stroke due to basilar occlusion with unclear onset. Radiological - but not clinical - stroke mimic in a patient with an impaired state of consciousness Moreover, endovascular treatment is allowed only in tertiary stroke centers, and inappropriate transferral from referring centers may result in overtriage of suspected stroke patients, slowing in-hospital workflow and timely stroke acute treatment. [Extracted from the article]

Cosimo I de' Medici (1519-1574) was the first Grand Duke of Tuscany. He was one of the most important members of the Medici family. He was an excellent conqueror and a good politician. Moreover, he was able to attract and encourage artists, scientists and architects to promote Florence as the cultural capital of the Italian Renaissance. Historical chronicles report that he suffered from a stroke when he was 49 years old. Together with the acute manifestation of stroke, he displayed peculiar symptoms. He had gait disturbances and sphincter dysfunctions. His language became poor and hard to understand. His mood was very fluctuating and in the last years of his life he was a short-tempered man. In addition, he had a characteristic symptom, so-called pathological laughing and crying. The course of his disease was slow and stuttering. Taken together, these data seem to be one of the first reports of pseudobulbar paralysis. The disease of Cosimo I was probably due to a chronic cerebral vasculopathy, known as small vessels disease. We discuss this hypothesis regarding an ancient clinical case, with the support of current studies. [ABSTRACT FROM AUTHOR]