PMC8420642_01
MRI brain images during acute admissions (grey arrows indicate area(s) of interest). 2015 admission: (A) diffusion weighted imaging (DWI) showing posterior circulatory artery (PCA) ischaemic strokes from 21/2 years prior; (B) contrast-enhanced MRI angiography (maximum intensity projection) showing remnant foetal PCA cerebrovasculature. 2018 admission: (C) DWI sequences of recurrence of stroke in first trimester of current pregnancy; (D) ongoing strokes during admission post-IVTPA.
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However, on day 6 she redeveloped right sided facial tingling with worsening right limb weakness power 3/5, and repeat MRI revealed three new small acute infarcts in the cerebellum, both PICA and SCA territories (Figure 1); we therefore added aspirin to the anticoagulation.
Cardiac MRI (pseudo-4-chamber view) revealing characteristic ILVNC morphology in segment 4-6 with non-compacted (NC)/compacted (C) ratio of >=2:1.
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Given the ongoing strokes despite full treatment we requested trans-oesophageal echocardiogram (TOE) which showed changes in keeping with ILVNC, further confirmed with cardiac MRI (Figure 2).