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The Clot Strikes Thrice: Case Report of a Patient with 3 Concurrent Embolic events

Chee-Keong Wee1, Tushar Divakar Gosavi11, Weiting Huang2

  • 1National Neuroscience Institute, Singapore General Hospital Campus, Singapore.

Acta Neurologica Taiwanica
|June 24, 2016
PubMed

Insights

Concurrent cerebral and systemic embolism are rare. A large left ventricular thrombus caused multiple emboli, but urgent anticoagulation after stroke led to a good outcome.

Area of Science:

  • Cardiology
  • Neurology

Background:

  • Concurrent cerebral and systemic embolism are uncommon, with acute myocardial infarction from coronary embolism being particularly rare.
  • Left ventricular thrombus is a known cause of systemic embolism.

Observation:

  • A 49-year-old man presented with cerebral infarction due to right posterior cerebral artery occlusion.
  • He subsequently developed chest pain and ST-elevation myocardial infarction, diagnosed as right coronary artery occlusion.
  • Further investigation revealed a right profunda femoris artery occlusion, indicating three concurrent embolic events.

Findings:

  • Echocardiography identified a large, mobile left ventricular thrombus as the source of the emboli.
  • Urgent anticoagulation therapy was initiated.
  • The patient recovered and was discharged after one month of rehabilitation with no further ischemic events.

Implications:

  • This case highlights the potential for a single left ventricular thrombus to cause widespread embolic events.
  • In select patients with high embolic risk, initiating urgent anticoagulation following acute ischemic stroke may be a viable treatment strategy.
  • Early diagnosis and management of left ventricular thrombus are crucial to prevent severe embolic complications.
Abstract

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