Metachronous Cardio-Cerebral Infarction: A Rehabilitation Conundrum in Dual Pathology Recovery

Cardio-cerebral infarction, the simultaneous (synchronous) or sequential (metachronous) occurrence of acute ischemic stroke and acute myocardial infarction, poses significant challenges in both acute care and rehabilitation. We describe a 52-yr-old man who presented with acute myocardial infarction followed by ischemic stroke diagnosed within hours, representing metachronous cardio-cerebral infarction. After initial thrombolysis and delayed percutaneous coronary intervention, he demonstrated significant cognitive and language impairments that limited participation in a standard outpatient cardiac rehabilitation program. A combined inpatient stroke-cardiac rehabilitation approach was implemented, incorporating attention process training, speech-language therapy, transcranial direct current stimulation, pharmacological neuromodulation with piracetam, and tailored aerobic reconditioning. After 4 wks of integrated therapy, the patient showed improvements in cognitive function, communication and exercise tolerance. This case illustrates the feasibility and necessity of an integrated, interdisciplinary rehabilitation model in cardio-cerebral infarction. Further research is required to develop structured rehabilitation protocols for this rare but complex condition.