Embolic Stroke Diagnosed by Elevated D-Dimer in a Patient With Negative TEE for Cardioembolic Source

Area of Science:

• Neurology
• Cardiology
• Hematology

Background:

• Cerebrovascular accidents (CVAs) with thromboembolic etiology pose significant risks.
• Atrial flutter can be associated with cardioembolic stroke.
• Transesophageal echocardiography (TEE) is a standard diagnostic tool for cardiac embolism.

Purpose of the Study:

• To report a case of thromboembolic stroke despite negative TEE findings.
• To emphasize the diagnostic utility of D-dimer in complex stroke cases.
• To highlight D-dimer's role in guiding anticoagulation therapy and preventing recurrence.

Main Methods:

• Case report of a patient with atrial flutter presenting with CVA.
• Utilized magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) for brain imaging.
• Monitored D-dimer levels before and after anticoagulation therapy.

Main Results:

• A patient with atrial flutter and negative TEE showed elevated D-dimer levels (1877 ng/mL).
• Brain MRI/MRA revealed recanalization of an embolic thrombus in the left middle cerebral artery distribution.
• D-dimer levels normalized after 3 months of anticoagulation.

Conclusions:

• Negative TEE does not exclude intracardiac thrombus or thromboembolic risk.
• Elevated D-dimer levels can be a valuable adjunct in diagnosing thromboembolism.
• D-dimer aids in guiding therapy decisions and reducing stroke recurrence risk.