Hemodynamic Stroke in Simultaneous Cardio Cerebral Infarction: A New Term for Cardiologist

We report an uncommon case of simultaneous cardio-cerebral infarction, due to Inferior – right ventricle ST Segment Elevation Myocardial Infarction (STEMI) with acute ischemic stroke. Incidence of cardio cerebral infarction is exceptionally rare, with an incidence rate as low as 0.009%. Hemodynamic compromise in patients with acute myocardial infarction may result in the cerebral blood flow reduction that cause hemodynamic stroke. Due to the rarity of this condition, there were no recommended therapeutics strategy. Mechanical reperfusion with PCI procedure may be a superior choice in the settings of acute cardio-cerebral infarction for restoring hemodynamic stability.

Echocardiographic Findings And Ischemic Stroke

In order to study cardiac pathology in different subtypes of ischemic stroke we examined 165 stroke patients. The 1st group included 90 (54.5%) patients with hemodynamic stroke, the 2nd one - 75 (45.5%) patients with cardioembolic stroke. Control group consisted of 45 individuals without cerebrovascular diseases. Cardiac pathologies with the prevalence of various types of ischemic heart disease were observed in all groups. The parameters of left ventricular stroke volume and ejection fraction were lower in patients with hemodynamic stroke than in other groups, but were within normal limits. Potential sources of cardiogenic embolism were found in all groups: in the 1st group at 74.4%, in the 2nd one at 100%. Thus, most patients with ischemic stroke have different heart defects related to the subtypes of ischemic stroke.

Cerebral Perfusion Imaging in Hemodynamic Stroke: Be Aware of the Pattern

Reduction of the cerebral perfusion pressure caused by vessel occlusion or stenosis is a cause of neurological symptoms and border-zone infarctions. The aim of this article is to describe perfusion patterns in hemodynamic stroke, to give a practical approach for the assessment of colour encoded CT- and MR-perfusion maps and to demonstrate the clinical use of comprehensive imaging in the workup of patients with hemodynamic stroke. Five patients with different duration cause and degree of hemodynamic stroke were selected. The patients shared the typical presentation with fluctuating and transient symptoms. All were examined by MR or CT angiography and MR or CT perfusion in the symptomatic phase. All patients were examined with diffusion weighted imaging. All five cases showed the altered perfusion patterns of hemodynamic insufficiency with a slight or marked increase in CBV in the supply area of the affected vessel and only slightly reduced or maintained CBF. The perfusion disturbances were most easily detected on the MTT maps. Border-zone infarctions were seen in all cases. The typical pattern for hemodynamic insufficiency is characterized by increased CBV, normal or decreased CBF and prolonged MTT in the affected areas. The increased CBV is the hallmark of stressed autoregulation. Reading the color-encoded perfusion maps enables a quick and robust assessment of the cerebral perfusion and its characteristic patterns. Internal border-zone infarctions can be regarded as a marker for hemodynamic insufficiency. Finding of the typical rosary-like pattern of DWI lesions should call for further work up.