Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA.
Department of Pediatric Surgery, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA.
Am J Case Rep. 2021 Jun 22;22:e931103. doi: 10.12659/AJCR.931103.
BACKGROUND Bilateral posterior cerebral artery (PCA) occlusions are exceedingly rare, and are considered a devastating phenomenon that presents as cortical blindness. Predominant causes of PCA infarcts include cardiac and arterial embolisms. Left ventricular noncompaction (LVNC) cardiomyopathy is also an extremely rare cardiopathology. Several reports describe stroke as a potential manifestation of LVNC, but bilateral PCA infarcts are likely also caused by underlying LVNC cardiomyopathy, although this has not yet been reported. CASE REPORT A 63-year-old man presented to the emergency department of an outside hospital with acute vision loss in both eyes and dysarthria. His neurological examination necessitated an emergent stroke evaluation. His electrocardiogram and telemetry at admission did not reveal arrhythmia. He underwent an emergency endovascular thrombectomy at our facility. During the post-intervention stroke workup, a transthoracic echocardiogram with contrast showed left ventricle dilation, with an ejection fraction (EF) of 29%. Subsequent cardiac magnetic resonance imaging confirmed the presence of LVNC cardiomyopathy. He was started on therapeutic anticoagulation (apixaban) and remained stable neurologically during the 3-month followup, with some residual visual field deficits. His cardiac outcome also improved (stress test was unremarkable for any cardiac ischemia, and an echocardiogram showing improved EF of 40%). CONCLUSIONS Our report is distinct, as it presents 2 exceedingly rare events in a patient: the occurrence of simultaneous bilateral PCA infarcts and LVNC cardiomyopathy. Prompt and accurate diagnosis was pivotal to the successful management of both conditions. Prospective studies are warranted to further knowledge of LVNC pathophysiology and the occurrence of stroke in such patients so that comprehensive management plans can be devised.
双侧大脑后动脉（PCA）闭塞极为罕见，被认为是一种灾难性现象，表现为皮质盲。PCA 梗死的主要原因包括心源性和动脉性栓塞。左心室心肌致密化不全（LVNC）心肌病也是一种极为罕见的心脏病。有几份报告描述了中风是 LVNC 的一种潜在表现，但双侧 PCA 梗死也可能由潜在的 LVNC 心肌病引起，尽管尚未有报道。
一名 63 岁男性因双眼急性视力丧失和构音障碍到外院急诊科就诊。他的神经系统检查需要紧急进行卒中评估。他入院时的心电图和遥测未显示心律失常。他在我们的机构接受了紧急血管内血栓切除术。在介入后卒中检查期间，经胸超声心动图（TEE）造影显示左心室扩张，射血分数（EF）为 29%。随后的心脏磁共振成像（CMR）证实存在 LVNC 心肌病。他开始接受治疗性抗凝治疗（阿哌沙班），在 3 个月的随访期间神经状态稳定，存在一些残留的视野缺损。他的心脏预后也有所改善（负荷试验未显示任何心肌缺血，超声心动图显示 EF 改善至 40%）。
我们的报告很独特，因为它在一名患者中同时出现了两种极为罕见的事件：同时发生双侧 PCA 梗死和 LVNC 心肌病。及时准确的诊断对这两种疾病的成功治疗至关重要。需要前瞻性研究来进一步了解 LVNC 的病理生理学和此类患者中风的发生情况，以便制定全面的管理计划。
