Also noticeable are cafe au lait spots. Auscultation of the neck elicits a very loud bruit in the region of the left carotid. There are no other focal sensory deficits. Good strength bilaterallly. No ataxia or dysmetria.
Reflexes are normal and symmetric.
No pathological reflexes. Remainder of the exam was normal. This led to a cerebral angiogram. In retrospect, the patient was probably describing symptoms of vertebrobasilar insufficiency. The AVF was between the left VA and the paravertebral venous plexus.