Simultaneous ST-Elevation Myocardial Infarction Without Obstructive Coronary Disease and Intracranial Hemorrhage...

Simultaneous arterial and venous thrombotic events across multiple vascular territories represent a rare and diagnostically challenging clinical scenario, particularly when accompanied by intracranial hemorrhage that limits therapeutic options. We present the case of a 56-year-old male with ST-elevation myocardial infarction (STEMI) caused by a large thrombus in the left anterior descending artery without underlying stenosis. His course was complicated by intracranial hemorrhage, acute kidney injury, thrombotic microangiopathy features, left ventricular thrombus, and recurrent ischemic strokes involving the left middle cerebral artery (MCA), left posterior cerebral artery (PCA), and acute right MCA occlusion. Extensive evaluation revealed diffuse thrombosis without a clear unifying diagnosis. Antiphospholipid syndrome was suspected; however, serologic confirmation was inconclusive. Malignancy-associated thrombosis was also considered.  This case demonstrates a complex differential diagnosis, and it highlights the limitations of current diagnostic testing. It also underscores the therapeutic dilemma of managing concurrent thrombosis and intracranial hemorrhage. Despite multidisciplinary care, the patient's course was fatal.