Presentation
Right hemiplegia. History of prior myocardial infarction.
Patient Data
Acute to subacute large left MCA territory infarct, without hemorrhagic transformation. Mild regional mass effect, with mild rightward midline shift of the septum pellucidum without frank herniation. Ipsilateral dense MCA.
Bilateral dependent lower lobe consolidation with retained tracheal secretions likely due to aspiration. Thinning of the left ventricular apex with aneurysm formation within the distribution of a prior left anterior descending artery with thrombus within the abnormal left ventricle.
Illustration of the 3 components of Virchow’s triad:
hypercoagulability
endothelial damage
stasis
Image credit: Stefan Tigges
The illustration shows an apical left ventricular aneurysm.
Image credit: Patrick J. Lynch (medical illustrator)
No changes were made to the original image.
For full attribution, see case discussion.
Comment: Patrick J. Lynch; illustrator; C. Carl Jaffe; MD; cardiologist Yale University Center for Advanced Instructional Media Medical Illustrations by Patrick Lynch, generated for multimedia teaching projects by the Yale University School of Medicine, Center for Advanced Instructional Media, 1987-2000.
Case Discussion
This person had a history of a prior myocardial infarction and presented with a left middle cerebral artery stroke. The left heart is a frequent source of emboli leading to stroke. Patients with atrial fibrillation or mitral valve disease are at risk for left atrial thrombus formation, especially within the left atrial appendage. Prior myocardial infarction often results in 2 components of Virchow's triad (abnormal endocardium and stasis) which put patients at risk for the development of left ventricular thrombus. In this case, a fragment of the left ventricular thrombus likely embolized to the left MCA, resulting in a stroke.
Image attribution: left ventricular aneurysm by Patrick J. Lynch
Author: Patrick J. Lynch (medical illustrator)
Original file: https://commons.wikimedia.org/wiki/File:Heart_lv_aneurysm_4c.jpg
Modification: no changes were made to the original image
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