Hemorrhagic stroke during the acute phase of myocardial infarction: a rare and difficult situation to manage

Rule out alternative causes before attributing cerebral hemorrhage to thrombolysis for coronary intervention

“…We do not agree with the statement in the case description that the presented patient had preserved left ventricular systolic function [1] . Since the ejection fraction was only 34%, the left ventricular systolic function has to be assessed as clearly reduced.…”

“…We read with interest the article by Boudihi et al. [1] on a 66-years-old patient with acute myocardial infarction complicated by atrial fibrillation and reduced systolic function resulting from subtotal stenosis of the left proximal circumflex artery. The patient was treated with systemic thrombolysis followed by angioplasty with stent placement and dual antiplatelet therapy for secondary prophylaxis [1] .…”

“… [1] on a 66-years-old patient with acute myocardial infarction complicated by atrial fibrillation and reduced systolic function resulting from subtotal stenosis of the left proximal circumflex artery. The patient was treated with systemic thrombolysis followed by angioplasty with stent placement and dual antiplatelet therapy for secondary prophylaxis [1] . Percutaneous coronary intervention (PCI) was complicated by intracerebral bleeding (ICB) in the left parietal lobe why the antiplatelet therapy was discontinued but restarted after 2 days due to recurrence of anginal chest pain [1] .…”

“…The patient was treated with systemic thrombolysis followed by angioplasty with stent placement and dual antiplatelet therapy for secondary prophylaxis [1] . Percutaneous coronary intervention (PCI) was complicated by intracerebral bleeding (ICB) in the left parietal lobe why the antiplatelet therapy was discontinued but restarted after 2 days due to recurrence of anginal chest pain [1] . The study is excellent but has limitations that raise concerns and should be discussed.…”

“…The transthoracic echocardiography shown in Figure 2 suggests Takotsubo syndrome (TTS) [1] . We should know whether there were any other indications for TTS, such as the typical ampulla sign on ventriculography during the coronary intervention.…”