Dhaliwal Jasninder Singh S, Ansari Saad Ali, Ghosh Sudeshna, Chitkara Akshit, Khizer Umair
Internal Medicine, University of California Riverside School of Medicine, Riverside, USA.
Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA.
Cureus. 2023 Jun 3;15(6):e39917. doi: 10.7759/cureus.39917. eCollection 2023 Jun.
We present the case of a 60-year-old male who developed an ischemic stroke due to left ventricular (LV) thrombus emboli as a complication of methamphetamine-induced cardiomyopathy. The patient had a history of methamphetamine abuse, hypertension, and ischemic stroke with no residual deficits presented with new onset slurred speech, left-sided weakness, and numbness for two hours. Computed tomography (CT) of the head showed no acute changes, and a tissue plasminogen activator was given in the emergency department within 30 minutes of arrival. Urine drug screen (UDS) was positive for methamphetamine, and magnetic resonance imaging (MRI) of the brain showed acute cortical infarcts in the right frontal lobe and parietal lobe and chronic infarct in the left occipital lobe. Transthoracic echocardiography showed bilateral ventricular thrombus and severely reduced ejection fraction of 20-25%. The patient had no evidence of thrombophilia and was started on a heparin drip for thrombus and goal-directed medical therapy for heart failure with reduced ejection fraction (HFrEF). Upon discharge, the patient was prescribed the oral anticoagulant rivaroxaban. The LV thrombus emboli were attributed to causing ischemic stroke. This case highlights the potential risk of ischemic stroke due to LV thrombus emboli in patients with methamphetamine-induced cardiomyopathy.
我们报告一例60岁男性患者，其因甲基苯丙胺所致心肌病的并发症——左心室（LV）血栓栓塞而发生缺血性卒中。该患者有甲基苯丙胺滥用、高血压和缺血性卒中病史，无残留神经功能缺损，此次因新发言语含糊、左侧肢体无力和麻木2小时就诊。头部计算机断层扫描（CT）未显示急性改变，患者在到达急诊科后30分钟内接受了组织纤溶酶原激活剂治疗。尿液药物筛查（UDS）显示甲基苯丙胺阳性，脑部磁共振成像（MRI）显示右额叶和顶叶急性皮质梗死以及左枕叶慢性梗死。经胸超声心动图显示双侧心室血栓形成，射血分数严重降低至20%-25%。患者无血栓形成倾向证据，开始接受肝素静脉滴注以治疗血栓，并针对射血分数降低的心力衰竭（HFrEF）进行目标导向的药物治疗。出院时，患者被处方口服抗凝药利伐沙班。左心室血栓栓塞被认为是导致缺血性卒中的原因。该病例凸显了甲基苯丙胺所致心肌病患者因左心室血栓栓塞而发生缺血性卒中的潜在风险。
