J Neurocrit Care.  2021 Dec;14(2):109-112. 10.18700/jnc.210030.

Which one to do first?: a case report of simultaneous acute ischemic stroke and myocardial infarction

• Lee K
• Park W
• Seo KD
• Kim H

• KMID: 2523721
• DOI: http://doi.org/10.18700/jnc.210030

Abstract

Background
Although there are common risk factors for acute ischemic stroke and myocardial infarction, simultaneous onset of both diseases is uncommon. Here, we present a case of acute cerebral infarction with concurrent fatal myocardial infarction.
Case Report
A 54-year-old man presented with left hemiparesis, gaze preponderance to the right side, and visual and tactile extinction. Computed tomography angiography showed occlusion of the right middle cerebral artery. ST-elevation myocardial infarction was suspected on electrocardiography. After the injection of intravenous tissue plasminogen activator, thrombectomy was attempted first, and the coronary angiogram was planned after recanalization of the cerebral artery. However, thrombectomy was discontinued because of cardiac arrest. Despite extracorporeal membrane oxygenation and emergency percutaneous coronary intervention, the patient died of multiorgan failure.
Conclusion
Double primary acute ischemic stroke and myocardial infarction are rare but may be fatal due to the narrow therapeutic time window for both diseases. Careful consideration of the urgency of cardiac status is essential.

Keyword

Acute ischemic stroke; Acute myocardial infarction; Cardiocerebral ischemic attack; Reperfusion therapy; Percutaneous coronary intervention; Case report

Figure

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  Fig. 1. (A) Brain computed tomography without enhancement demonstrates low density in the right insula, corona radiate, and temporal lobe (white arrowheads). Sulcal effacement is also noted in right frontal and temporal lobe. (B) Brain computed tomography angiogram demonstrates occlusion of the M1 segment of the right middle cerebral artery (white arrow). Severe stenosis is also noted in the right distal internal carotid artery (black arrowhead). (C) Perfusion image shows increased Tmax value in the right middle and posterior cerebral artery territory.

• 

  Fig. 2. (A) Electrocardiogram shows ST-segment elevation in II, III, and aVF with reciprocal ST depression in V5 and V6, suggesting acute inferior myocardial infarction. (B) Emergency coronary angiogram shows the culprit lesion in the right coronary artery before stenting (black arrow). (C) After percutaneous coronary intervention, recanalization of right coronary artery is achieved.

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