Cardio-cerebral infarction after syncope: a case report

Cardio-cerebral infarction (CCI) initially introduced by Omar et al. in 2010, pertains to the concurrent manifestation of acute ischemic stroke (AIS) and acute myocardial infarction (AMI). In this study, we presented a 50-year-old man who arrived at the emergency department (ED) with syncope 6 hours prior. Neurological examination revealed left nasolabial fold flattening and left hemiparesis. Computed Tomography (CT) brain scan showed no intracranial hemorrhage, while diffusion brain Magnetic Resonance Imaging (MRI) displayed restricted diffusion of the right centrum ovale in the periventricular space. Electrocardiogram (ECG) indicated subacute ST-segment elevation in V2-V4, which resulted in the diagnosis of CCI. Due to ST-elevated MI, he received aspirin, ticagrelor, and heparin before undergoing emergent coronary angiography. After multidisciplinary discussion, the patient was planned for Coronary Artery Bypass Graft (CABG) surgery. His acute ischemic stroke was medically managed with antiplatelet and anticoagulant therapy. CCI is a rare and high-mortality disease arising from the simultaneous occurrence of AIS and AMI. Due to its rarity, there's no consensus on its treatment. The treatment process for AIS is limited to the patient's suitability for thrombolytic and thrombectomy therapy. We advise using a hybrid angiography laboratory for AIS patients.