PMC7653271_01
ECG of the patient on presentation showing inferior ST-elevation myocardial infarction (STEMI) with a lateral extension.
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The patient was taken by the family to a nearby hospital where an electrocardiogram (ECG) and a brain computed tomography (CT) scan were done and showed acute inferior ST-elevation myocardial infarction (STEMI) with a lateral extension (Figure 1) and acute large right middle cerebral artery (MCA) ischemic stroke with the hemorrhagic transformation (Figure 2).
CT brain without contrast showing evidence of a large hypoattenuating area seen involving the right fronto-parietal region with loss of the gray-white matter differentiation containing few hyperdense foci associated with right cerebral hemispheric edema, effacement of sulci, compression effect on the ipsilateral lateral ventricle and midline shift to the left side measuring about 3 mm, overall findings representing acute right MCA territory infarction with hemorrhagic transformation.
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The patient was taken by the family to a nearby hospital where an electrocardiogram (ECG) and a brain computed tomography (CT) scan were done and showed acute inferior ST-elevation myocardial infarction (STEMI) with a lateral extension (Figure 1) and acute large right middle cerebral artery (MCA) ischemic stroke with the hemorrhagic transformation (Figure 2).
Brain MRI: (A-C) T2, FLAIR and DWI showing right MCA territory infarction. A small chronic ischemic lesion seen in the white matter of the left frontal lobe. (D) SWI image showing blooming artifacts at the site of infarction representing blood component (hemorrhagic transformation).
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Additional tests were conducted including a brain Magnetic Resonance Imaging (MRI) which showed the same above-mentioned findings on the CT scan in addition to a small area of chronic ischemic nature in the periventricular white matter of the left frontal lobe (Figure 3).
Brain CTA showing a Lesser extent of opacification of the cortical branches of right MCA compared to the left.
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Head CT angiography (CTA) was remarkable for occluded branches of the right MCA (Figure 4).
Transesophageal echocardiogram (TEE) images showing ascending aorta thrombus.
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Transesophageal echocardiogram (TEE) showed a fresh, freely oscillating, 1.6 *1.2 cm thrombus attached to the wall of the ascending aorta just above the right coronary artery sinus (Figure 5).
Chest CTA showing non-occlusive filling defects at the origin of the Brachiocephalic artery and in the proximal ascending aorta.
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Chest CTA showed another thrombus at the origin of the brachiocephalic trunk (Figure 6).