Simultaneous cardio-cerebral embolization associated with atrial fibrillation: a case report

Abstract

Background: Simultaneous cerebral and myocardial infarction is called cardiocerebral infarction (CCI), and is rarely encountered. Because of the narrow time window and complex pathophysiology, CCI is challenging to immediately diagnose and treat. Case presentation: A 73-year-old woman suddenly developed right hemiplegia and severe aphasia. Twelve-lead electrocardiography showed tachycardic atrial fibrillation without any significant ST-T change. Magnetic resonance imaging revealed a proximal middle cerebral artery occlusion. She was immediately treated with alteplase at the dosage approved for ischemic stroke followed by mechanical thrombectomy as bridging therapy, and complete recanalization was achieved. Aphasia improved and she began to complain of chest pain, and reported that she had experienced chest discomfort just prior to right limb weakness. Coronary angiography showed a partial filling defect in the right coronary artery with rapid and adequate distal flow, for which percutaneous coronary intervention was not required. Alteplase was suggested to have effectively resolved the coronary emboli. The occlusions of the cerebral and coronary arteries were assumed to have occurred nearly simultaneously and cardiogenic embolism due to atrial fibrillation was considered as the most likely etiology. Conclusions: As seen in the present case, CCI may benefit from immediate treatment with intravenous tissue plasminogen activator (IV-tPA). Although which of percutaneous coronary intervention or cerebral thrombectomy should be performed first remains unclear, we must decide whether to rescue the brain or heart first in each patient within a limited window of time. This dilemma has recently become evident in this era with mechanical thrombectomy strongly established as an effective intervention for acute ischemic stroke. Close cooperation between stroke physicians and cardiologists is becoming more important.

A case of cardiac tamponade during the treatment of simultaneous cardio-cerebral infarction associated with atrial fibrillation – Case report

“…Table 1: Previous reports on cardiocerebral embolization. [1,[6][7][8][9]11,12,15] Author/year Age/Sex Chief complaint rupture due to AMI. e blood pressure gradually increased, and the patient no longer needed any vasopressors.…”

“…Table 1 shows previously reported 13 patients with CCI as far as we know. [1,[6][7][8][9]12,15] Among the 13 reported patients, the 11 patients did not receive oral anticoagulation before the event, and the ones [11] had both heparin and warfarin, or dual antiplatelet therapy each. Our patient had rivaroxaban but suffered from CCI.…”