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Clinicopathological Conference
Three Strokes and a Heart Attack in a Fit and Relatively Young Woman
  1. Mirdhu Wickremaratchi*,
  2. Tom Hughes*,
  3. Charles Warlow†,
  4. Maggie Hourihan‡,
  5. Alistair Lammie§
  1. *Departments of Neurology,
  2. ‡Neuroradiology and
  3. §Pathology, University Hospital of Wales, Heath Park, Cardiff, UK and
  4. †Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK; E-mail: Tom.Hughes{at}UHW-TR.wales.nhs.uk

Abstract

THE STORY

A 52-year-old female presented on 3 July 2001 with the sudden onset of nausea, vomiting and double vision. On admission she was drowsy and vague with a right hemiparesis, poor coordination of the right side, and a right inferior homonymous quadrantinopia. A CT brain scan on 4 July excluded intracerebral haemorrhage and was repeated with and without contrast on the 16 July (Fig. 1). She gradually improved and was discharged home 2 weeks later, independently mobile.

On 12 August 2001 she was woken by central crushing chest pain. An ECG showed acute inferior myocardial infarction and the troponin T level was raised at 1.78. Thrombolysis was not given. Six hours after admission she became drowsy and weak down the left side. There was difficulty with voluntary control of gaze, left sided visual inattention, a left hemiparesis and bilateral extensor plantars. Brain CT showed infarction in part of the

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