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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 …
Contributors YA-A and AAD contributed equally to this paper, from data gathering, echocardiography interpretation and writing the manuscript, while LO contributed in echocardiography interpretation. YA-A is responsible for the overall content as guarantor.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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