title: Hemorrhagic cardioembolic stroke secondary to a left ventricular thrombus: a therapeutic dilemma.
abstract: Cardiogenic embolism is a major cause of stroke and often leads to significant morbidity and mortality. Despite the recent advances in our understanding of the pathophysiology of stroke and its risk factors, diagnosis and therapy; some case scenarios still present a real challenge for the treating physicians. We report a case of a 50 year old male patient presenting with multi-territory cerebral infarctions due to a left ventricular mobile thrombus complicated with hemorrhagic transformation at the time of presentation. Gradual introduction of anticoagulation coupled with a multidisciplinary team approach advocating careful daily clinical assessment of the patient and regular echocardiographic and neuroimaging studies have resulted in a better management and achievement of therapeutic goals.
authors: Consultant, Department of Hematology, Sultan Qaboos University Hospital, P.O. Box 35, AlKhodh 123, Muscat, Sultanate of Oman.
authors: Khalil
authors: K
authors: Al-Farsi
authors: Aftab A
authors: AA
authors: Siddiqui
authors: Yasser W
authors: YW
authors: Sharef
authors: Ali K
authors: AK
authors: Al-Belushi
authors: Hakeem
authors: H
authors: Al-Hashim
authors: Mohammed
authors: M
authors: Al-Ghailani
authors: William J
authors: WJ
authors: Johnston
keywords: Cardioembolism; Echocardiography; Hemorrhagic transformation; Mobile thrombus; Multidisciplinary approach; Stroke
references: Arch Neurol. 2000 Dec;57(12):1710-3
references: 11115236
references: West J Med. 1989 Aug;151(2):172-9
references: 2672600
references: Chest. 2001 Feb;119(2):478-84
references: 11171726
references: J Am Coll Cardiol. 1985 Jun;5(6):1276-80
references: 3998310
references: Chest. 2008 Jun;133(6 Suppl):630S-669S
references: 18574275
references: Stroke. 1988 Mar;19(3):407-8
references: 3354032
references: Arch Neurol. 1986 Jan;43(1):71-84
references: 3510609
references: Intern Med. 1997 Feb;36(2):92-6
references: 9099589
references: Stroke. 2000 Jul;31(7):1770-8
references: 10884486
references: Stroke. 2003 Jun;34(6):e45-6
references: 12730559
references: Stroke. 2011 Jan;42(1):227-76
references: 20966421
references: Stroke. 1981 Jan-Feb;12(1):1
references: 7222150
references: Stroke. 2004 Jan;35(1):e5-6; author reply e5-6
references: 14671234
references: Stroke. 1983 Jan-Feb;14(1):42-6
references: 6823685
references: Int J Cardiol. 2004 Jun;95(2-3):129-34
references: 15193810
references: Stroke. 1989 May;20(5):598-603
references: 2718199
references: Stroke. 1986 Mar-Apr;17(2):179-85
references: 3515635
references: Neurology. 1978 Aug;28(8):754-62
references: 567291
references: J Neurol. 2000 Mar;247(3):209-14
references: 10787117
references: Circulation. 1982 Jul;66(1):156-66
references: 7083502
references: Stroke. 1984 Sep-Oct;15(5):779-89
references: 6474527
references: Stroke. 1993 Mar;24(3):465-8
references: 8446984
references: Curr Treat Options Cardiovasc Med. 2001 Dec;3(6):515-521
references: 11696271
references: Stroke. 2002 Jul;33(7):1927-33
references: 12105378
references: J Am Coll Cardiol. 1989 Mar 1;13(3):554-64
references: 2918160
references: Neurology. 1995 May;45(5):861-5
references: 7746397
references: Circulation. 2007 May 22;115(20):e478-534
references: 17515473
references: J R Soc Med. 2004 Jun;97(6):308-9
references: 15173340
references: Stroke. 1980 Sep-Oct;11(5):433-42
references: 6999670
references: Arch Neurol. 1989 Jul;46(7):727-43
references: 2662950
references: Stroke. 2010 Dec;41(12):2860-6
references: 21030703
references: Stroke. 1983 Sep-Oct;14(5):668-76
references: 6362091
references: Stroke. 2007 Feb;38(2):423-30
references: 17204681