Kc Manish, Bhattarai Himal Bikram, Adhikari Subodh, Mandal Prince, Kashyap Ashutosh, Thapa Neeraj, Mehera Ishita
North Alabama Medical Center, 1701 Veterans Dr, Florence, AL.
Dubai London Hospital, Dubai, United Arab Emirates.
Ann Med Surg (Lond). 2024 Apr 23;86(8):4762-4766. doi: 10.1097/MS9.0000000000002069. eCollection 2024 Aug.
Stroke, a global health concern, often results from embolic events of cardiac origin. Coxsackie B virus (CBV) myocarditis, a common cause of viral heart infections, can lead to cardiac thrombi formation, subsequently causing devastating complications such as embolic stroke. The authors present a rare case of a 26-year-old male who experienced an embolic stroke following CBV myocarditis and cardiomyopathy.
The patient exhibited left-sided weakness, facial droop, and respiratory distress. Laboratory findings indicated leukocytosis, hyponatremia, and elevated troponin I. Imaging revealed an acute right basal ganglia infarct and multifocal pulmonary embolism. The diagnosis involved positive CBV serology, severely reduced left ventricular function, and a large apical thrombus.
Cardioembolic strokes, often attributable to atrial fibrillation, can also result from intracardiac thrombosis associated with myocarditis. CBV, implicated in up to 40% of acute myocarditis cases, binds to cardiac myocytes, triggering inflammation and potential thrombus formation. Myocarditis-induced hypercoagulability increases the risk of thromboembolic events, complicating the clinical course.
CBV myocarditis poses a risk of heart failure, cardiomyopathy, and thromboembolic complications such as embolic stroke. Vigilant monitoring for complications and prompt management is crucial, as primary disease treatment remains primarily supportive. This case highlights the need for increased awareness and further studies to understand the intricate relationship between viral myocarditis and embolic strokes.
中风是一个全球性的健康问题，通常由心脏源性栓塞事件引起。柯萨奇B病毒（CBV）心肌炎是病毒性心脏感染的常见原因，可导致心脏血栓形成，随后引发诸如栓塞性中风等毁灭性并发症。作者报告了一例罕见病例，一名26岁男性在患CBV心肌炎和心肌病后发生了栓塞性中风。
患者出现左侧肢体无力、面部下垂和呼吸窘迫。实验室检查结果显示白细胞增多、低钠血症和肌钙蛋白I升高。影像学检查发现急性右侧基底节梗死和多发性肺栓塞。诊断依据包括CBV血清学阳性、左心室功能严重降低以及心尖部有一个大血栓。
心源性栓塞性中风通常归因于心房颤动，也可由与心肌炎相关的心脏内血栓形成引起。在高达40%的急性心肌炎病例中涉及的CBV，会与心肌细胞结合，引发炎症并可能形成血栓。心肌炎引起的高凝状态增加了血栓栓塞事件的风险，使临床病程复杂化。
CBV心肌炎会引发心力衰竭、心肌病以及诸如栓塞性中风等血栓栓塞性并发症的风险。由于原发性疾病的治疗主要是支持性的，因此对并发症进行密切监测并及时处理至关重要。该病例凸显了提高认识以及开展进一步研究以了解病毒性心肌炎与栓塞性中风之间复杂关系的必要性。
