PMC4857345_01
A 12-lead EKG shows atrial fibrillation with ST elevation in leads II, III, and aVF.. EKG: electrocardiogram; aVF: augmented vector foot.
10.1177_2050313X14530283-fig1.jpg
PMC4857345_01_10.1177_2050313X14530283-fig1.jpg
fig1-2050313X14530283
On presentation the admission electrocardiogram (EKG) showed ST elevation in the II, III, augmented vector foot (aVF) (Figure 1).
Day of cardiac catheterization: (a) CT scan of brain without IV contrast shows hyperdensity in the right frontoparietal region (90 HU) and (b) 24 h later CT scan of brain without IV contrast shows significant interval improvement of hyperdensity in right frontoparietal region since the first CT scan (30 HU) with more diffuse distribution.. CT: computed tomography; IV: intravenous.
10.1177_2050313X14530283-fig2.jpg
PMC4857345_01_10.1177_2050313X14530283-fig2.jpg
fig2-2050313X14530283
CT of the brain without intravenous (IV) contrast was done and it revealed hyperdensity (90 HU (Hounsfield unit)) in the right frontoparietal region with effacement of sulci which was read as SAH by radiologist (Figure 2(a)). CT angiogram of the brain/neck with 90 ml nonionic contrast was performed, which did not reveal any hemodynamically significant stenosis or intracranial aneurysm, and the patient was admitted to the coronary care unit for further observation and management. HU) in the right frontoparietal region with a more diffuse distribution (Figure 2(b)). Her serum troponin level continued to rise and peaked on the second day of hospitalization at 71 ng/mL.
MRI images of brain T1, T2, and FLAIR sequences show no abnormal signal within brain parenchyma. (a) MRI T1 weighted image shows no abnormal signal within brain parenchyma, (b) MRI T2 weighted image shows no abnormal signal within brain parenchyma, and (c) MRI FLAIR image shows no abnormal signal within brain parenchyma.. MRI: magnetic resonance imaging; FLAIR: fluid-attenuated inversion recovery.
10.1177_2050313X14530283-fig3.jpg
PMC4857345_01_10.1177_2050313X14530283-fig3.jpg
fig3-2050313X14530283
T1, T2 or fluid-attenuated inversion recovery (FLAIR) sequences (Figure 3(a)-(c)) to suggest the presence of acute or subacute stroke. There was no aneurysm or vascular malformation noted on the MRI and after discussion with neurology, dilantin was stopped.