Left ventricular thrombus in acute cardioembolic stroke: A case report

Rationale: Although traditionally linked to myocardial dysfunction, left ventricular (LV) thrombus with preserved systolic function presents a distinct diagnostic challenge, necessitating its consideration in all cardioembolic strokes. Patient’s Concern: A 50-year-old woman with diabetes experienced sudden unresponsiveness accompanied by significant right upper limb weakness. Remarkably, her clinical history was devoid of symptoms suggestive of ischemic or arrhythmic cardiac events. Diagnosis: Advanced neuroimaging identified acute bilateral medial thalamic and paramedian midbrain infarctions. Transthoracic echocardiography revealed an unexpectedly large, mobile LV thrombus, coexisting with normal systolic function (ejection fraction: 60%). Interventions: Immediate anticoagulation with low molecular weight heparin was initiated, followed by oral warfarin titrated to an international normalized ratio of 2.0-3.0. Physical therapy was implemented to address residual motor deficits. Outcomes: Three months post-intervention, the patient demonstrated marked neurological improvement (right upper limb power: 3/5) and complete thrombus resolution, confirmed by follow-up echocardiography. Lessons: This case highlights that LV thrombus is a rare but critical consideration in embolic stroke of uncertain origin, even with normal cardiac function. It underscores the necessity of prompt echocardiography and early anticoagulation to achieve optimal outcomes.