Dilated cardiomyopathy-related stroke mimicking large-artery atherosclerosis-related stroke: report of two cases
1Department of Neurology, The Third Aﬃliated Hospital of Shenzhen University, 518000 Shenzhen, Guangdong, China
2Department of Neurology, The First Aﬃliated Hospital of Shenzhen University, 518000 Shenzhen, Guangdong, China
3Department of Neurology, Shenzhen Second People's Hospital, 518000 Shenzhen, Guangdong, China
4Department of Neurology, The Third People's Hospital of Yiyang City, 413000 Yiyang,Hunan, China
5Business School, Manchester Metropolitan University, M15 6BH Manchester, UK
DOI: 10.22514/sv.2021.211 Vol.17,Issue 6,November 2021 pp.150-156
Submitted: 09 July 2021 Accepted: 13 August 2021
Published: 08 November 2021
† These authors contributed equally.
The clinical characteristics and treatment of stroke caused by dilated cardiomyopathy (DCM) are not clear, especially in patients with large-artery atherosclerosis (LAA)-related stenosis, which commonly causes acute ischemic stroke (AIS); therefore, the diagnosis and treatment of such patients are challenging. Herein, we summarize the clinical characteristics and suggest clues to guide the diagnosis and treatment of two cases. Case 1: A 67-year-old woman with a history of DCM presented with sudden-onset slurred speech and left limb weakness (>2 hours duration), which worsened after intravenous thrombolysis. Repeated brain computed tomography showed no hemorrhage; thus, cerebral artery occlusion or embolism was suspected. Emergency magnetic resonance imaging (MRI) and angiography (MRA) revealed acute multiple bilateral cerebral infarctions and severe left middle cerebral artery stenosis, respectively. We considered a DCM-related stroke and administered anticoagulation therapy. Subsequently, the patient’s symptoms improved significantly, and she was discharged on day 9, after showing no abnormal neurological signs. Case 2: A 49-year-old man with a history of DCM presented with acute headache and blurred vision for 4 days. MRI and MRA revealed multiple acute cerebral infarctions and left vertebral artery stenosis, respectively. We considered an LAA-related stroke and administered antiplatelet and cholesterol-lowering drugs. Eventually, the patient was discharged on day 13, after his right-sided hemianopia improved significantly. Both patients had LAA, which can be easily misdiagnosed as a stroke. LAA-related and DCM-related stroke need to be differentiated. DCM-related AIS lesions are often distributed in the areas supplied by the different cerebral arteries. It is necessary to carefully analyze the shape, location, and scope of the lesions, and identify the main causes of stroke. Anticoagulant therapy is preferred for DCM-related AIS.
Dilated cardiomyopathy; Stroke; Large artery atherosclerosis; Anticoagulation therapy; Case report
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