Hyperacute Simultaneous Cardiocerebral Infarction: Rescuing the Brain or the Heart First?

Kijpaisalratana, Naruchorn; Chutinet, Aurauma; Suwanwela, Nijasri C.

doi:10.3389/fneur.2017.00664

Cited by 41 publications

(44 citation statements)

References 33 publications

(52 reference statements)

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“…Regarding the 2 patients in whom PCI was implemented first, circulatory dynamics were unstable. Although which of PCI or cerebral thrombectomy should be performed first remains unclear, a decision algorithm for acute management of CCI has been proposed [13], in which cerebral thrombectomy can be prioritized if the circulatory dynamics are stable. Nonetheless, we must decide to rescue the brain or heart first 6 in each patient within a limited window of time.…”

Section: Discussionmentioning

confidence: 99%

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Simultaneous cardio-cerebral embolization associated with atrial fibrillation: a case report

Abe

Tanaka²,

Yamagami

et al. 2019

Preprint

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Background: Simultaneous cerebral and myocardial infarction is called cardiocerebral infarction (CCI), and is rarely encountered. Because of the narrow time window and complex pathophysiology, CCI is challenging to immediately diagnose and treat. Case presentation: A 73-year-old woman suddenly developed right hemiplegia and severe aphasia. Twelve-lead electrocardiography showed tachycardic atrial fibrillation without any significant ST-T change. Magnetic resonance imaging revealed a proximal middle cerebral artery occlusion. She was immediately treated with alteplase at the dosage approved for ischemic stroke followed by mechanical thrombectomy as bridging therapy, and complete recanalization was achieved. Aphasia improved and she began to complain of chest pain, and reported that she had experienced chest discomfort just prior to right limb weakness. Coronary angiography showed a partial filling defect in the right coronary artery with rapid and adequate distal flow, for which percutaneous coronary intervention was not required. Alteplase was suggested to have effectively resolved the coronary emboli. The occlusions of the cerebral and coronary arteries were assumed to have occurred nearly simultaneously and cardiogenic embolism due to atrial fibrillation was considered as the most likely etiology. Conclusions: As seen in the present case, CCI may benefit from immediate treatment with intravenous tissue plasminogen activator (IV-tPA). Although which of percutaneous coronary intervention or cerebral thrombectomy should be performed first remains unclear, we must decide whether to rescue the brain or heart first in each patient within a limited window of time. This dilemma has recently become evident in this era with mechanical thrombectomy strongly established as an effective intervention for acute ischemic stroke. Close cooperation between stroke physicians and cardiologists is becoming more important.

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Section: Discussionmentioning

confidence: 99%

“…[12][13][14][15]. When treating CCI patients with IV-tPA, close attention is required because the etiology of CCI includes aortic dissection[16][17], which is a contraindication for IV-tPA.…”

mentioning

confidence: 99%

Simultaneous cardio-cerebral embolization associated with atrial fibrillation: a case report

Abe

Tanaka²,

Yamagami

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…Regarding the 2 patients in whom PCI was implemented first, circulatory dynamics were unstable. Although which of PCI or cerebral thrombectomy should be performed first remains unclear, a decision algorithm for acute management of CCI has been proposed [10], in which cerebral thrombectomy can be prioritized if the circulatory dynamics are stable. Nonetheless, we must decide to rescue the brain or heart first in each patient within a limited window of time.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous cardio-cerebral embolization due to atrial fibrillation: a case report

Abe

Tanaka²,

Yamagami

et al. 2019

Preprint

View full text Add to dashboard Cite

Background Simultaneous cerebral and myocardial infarction is called cardiocerebral infarction (CCI), and is rarely encountered. Because of the narrow time window and complex pathophysiology, CCI is challenging to immediately diagnose and treat. Case presentation A 73-year-old woman suddenly developed right hemiplegia and severe aphasia. Twelve-lead electrocardiography showed tachycardic atrial fibrillation without any significant ST-T change. Magnetic resonance imaging revealed a proximal middle cerebral artery occlusion. She was immediately treated with alteplase at the dosage approved for ischemic stroke followed by mechanical thrombectomy, and complete recanalization was achieved. Aphasia improved and she began to complain of chest pain, and reported that she had experienced chest discomfort just prior to right limb weakness. Coronary angiography showed a partial filling defect in the right coronary artery with rapid and adequate distal flow, for which percutaneous coronary intervention was not required. Alteplase was suggested to have effectively resolved the coronary emboli. The occlusions of the cerebral and coronary arteries were assumed to have occurred nearly simultaneously and cardiogenic embolism due to atrial fibrillation was considered as the most likely etiology. Conclusions As seen in the present case, CCI may benefit from immediate treatment with intravenous tissue plasminogen activator (IV-tPA). Although which of percutaneous coronary intervention or cerebral thrombectomy should be performed first remains unclear, we must decide to rescue the brain or heart first in each patient within a limited window of time. In this era with both IV-tPA and mechanical thrombectomy robustly established as effective intervention for acute ischemic stroke, close cooperation between stroke physicians and cardiologists is becoming more important.

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“…Table 1: Previous reports on cardiocerebral embolization. [1,[6][7][8][9]11,12,15] Author/year Age/Sex Chief complaint rupture due to AMI. e blood pressure gradually increased, and the patient no longer needed any vasopressors.…”

Section: Case Presentationmentioning

confidence: 99%

A case of cardiac tamponade during the treatment of simultaneous cardio-cerebral infarction associated with atrial fibrillation – Case report

Katsuki¹,

Katsuki²

2019

Surgical Neurology International

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Background: Simultaneous cerebral and myocardial infarction is called cardio-cerebral infarction (CCI). It is a rare condition, and its management strategy has yet to be determined. We report a case of cardiac tamponade during the treatment of CCI associated with atrial fibrillation. Case Description: A 72-year-old man presented with loss of consciousness after chest discomfort. He had taken rivaroxaban for paroxysmal atrial fibrillation. Twelve-lead electrocardiography showed ST elevation at II, III, and aVF. His National Institutes of Health Stroke Scale was 29. We diagnosed him with synchronous cardioembolic stroke and acute myocardial infarction due to atrial fibrillation. The coronary angiography revealed distal occlusion in the posterior descending branch of the right coronary artery, and overall myocardial perfusion seemed sufficient. The diffusion-weighted image showed hyperintense lesions at the cerebellum, and magnetic resonance angiography did not reveal the flow of the basilar artery. The patient’s NIH score improved immediately, so we did not perform intravenous tissue plasminogen activator (IV-tPA) administration nor endovascular treatment. Heparin administration was started. After 38 h from the onset, he suffered from hydrocephalus, and cerebral ventricular drainage was performed. Subsequently, circulatory dynamics worsened, and he was diagnosed with cardiac tamponade. Emergency pericardiotomy was performed, and he has been taking intensive care. Conclusion: Some cases with CCI treated with IV-tPA and endovascular intervention were reported, but the treatment strategy should be still discussed multidisciplinary. Especially, the administration of antithrombotic drugs for CCI should be carefully performed because fatal hemorrhage such as cardiac tamponade can occur.

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Hyperacute Simultaneous Cardiocerebral Infarction: Rescuing the Brain or the Heart First?

Cited by 41 publications

References 33 publications

Simultaneous cardio-cerebral embolization associated with atrial fibrillation: a case report

Simultaneous cardio-cerebral embolization associated with atrial fibrillation: a case report

Simultaneous cardio-cerebral embolization due to atrial fibrillation: a case report

A case of cardiac tamponade during the treatment of simultaneous cardio-cerebral infarction associated with atrial fibrillation – Case report

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