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Ischaemic stroke after ST-elevation myocardial infarction
  1. Yahya Al-Ansari,
  2. Lynda Otalvaro,
  3. Abdulla A Damluji
  1. Cardiovascular Division and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospital, Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Dr Abdulla A Damluji, Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Clinical Research Building 1120 NW 14 Street, (C-205) CRB 11th Floor Miami, FL 33136, USA; adamluji{at}med.miami.edu

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Clinical introduction

A 67-year-old Hispanic man presented with 5-h history of typical chest pain and an ECG consistent with inferior ST-elevation myocardial infarction (STEMI). Coronary angiography revealed an occluded proximal right coronary artery, and a percutaneous intervention with drug eluting stent was performed. He was started on aspirin and clopidogrel. Two weeks later, he was admitted with loss of consciousness, tonic-clonic seizure and urinary incontinence. On physical examination, he was unresponsive to tactile stimuli. Cardiac examination revealed a prominent left ventricular heave. Neurological examination showed a left lateral gaze. Initial evaluation with brain MRI revealed focal areas of restricted diffusion within the cerebral and cerebellar hemispheres, consistent with an acute embolic phenomenon. ECG showed new-onset atrial fibrillation, inferior infarct …

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