Ataxia-hemiparesis and cardiac embolic disease

Ataxia-hemiparesis is a clinical stroke syndrome with mild weakness and ataxia out of proportion to the weakness. Although most patients with ataxia-hemiparesis have small (lacunar) infarctions in the brainstem, internal capsule, or corona radiata, the syndrome has also been reported with infection, hemorrhage, and neoplasm in the same region. We now report a patient who presented with right ataxia-hemiparesis whose initial cranial computed tomography (CT) scan was normal and a second CT scan showed infarctions in the right cerebellum, left thalamus, and left frontal cortex. Initial echocardiogram showed segmental akinesis; a second study revealed a thrombus in the left ventricle. Ataxia-hemiparesis can sometimes be secondary to multiple infarcts resulting from cardiac emboli. In such cases, early recognition and anticoagulation could help prevent recurrences.