Abstract
An 86 year-old female presented acutely to the regional stroke centre with aphasia and right-sided weakness. In the department, her neurology fluctuated, including aphasia, pupillary dilation on the left and variable right-sided weakness. MRI, CT head and CT angiography did not demonstrate any acute intracranial cause for her neurological presentation. She had multiple episodes of symptomatic third degree atrioventricular block with ventricular standstill, followed by short episodes of self-resolving atrial fibrillation. She was treated with isoprenaline and transferred to the tertiary cardiology centre for urgent pacing. Her neurological presentation was felt to be secondary to bradycardia-related cerebral hypoperfusion resulting in transient neurological sequelae. Stroke clinicians should be aware of this potentially under-reported stroke mimic, as atrioventricular block with loss of cardiac output is a class I indication for emergency pacing.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Rudd M, Buck D, Ford GA, Price CI. A systematic review of stroke recognition instruments in hospital and prehospital settings. Emerg Med J. 2016;33:818–22.
Gibson LM, Whiteley W. The differential diagnosis of suspected stroke: a systematic review. J R Coll Physicians Edinb. 2013;43:114–8.
**an Y, Federspiel JJ, Cox M, Hernandez AF, Kosinski AS, Bettger JP, et al. Use of intravenous tissue plasminogen activator in patients without a stroke (stroke mimics): findings from the get with the guidelines stroke registry. Stroke. 2016;47:AWMP34.
McClelland G, Rodgers H, Flynn D, Price CI. The frequency, characteristics and aetiology of stroke mimic presentations. Eur J Emerg Med. 2019;26(1):2–8. https://doi.org/10.1097/MEJ.0000000000000550.
Barra SN, Providência R, Paiva L, Nascimento J, Marques AL. A review on advanced atrioventricular block in young or middle-aged adults. Pacing Clin Electrophysiol. 2012;35(11):1395–405. https://doi.org/10.1111/j.1540-8159.2012.03489.
Scheffold N, Herkommer B, Kandolf R, May AE. Lyme carditis—diagnosis, treatment and prognosis. Dtsch Arztebl Int. 2015;112(12):202–8. https://doi.org/10.3238/arztebl.2015.0202.
Ryan DJ, Harbison JA, Meaney JF, Rice CP, King-Kallimanis B, Kenny RA. Syncope causes transient focal neurological symptoms. QJM. 2015;108(9):711–8. https://doi.org/10.1093/qjmed/hcv005.
de Bono DP, Warlow CP, Hyman NM. Cardiac rhythm abnormalities in patients presenting with transient non-focal neurological symptoms: a diagnostic grey area? Br Med J (Clin Res Ed). 1982;284:1437. https://doi.org/10.1136/bmj.284.6327.1437.
Pilling JB, Nanton MA. Progressive external ophthalmoplegia and heart block. Br Med J. 1974;1(5906):492–3. https://doi.org/10.1136/bmj.1.5906.492.
Gregoratos D, Cheitlin M, Conill A, et al. ACC/AHA guidelines for implantation of cardiac pacemakers and antiarrhythmia devices: executive summary. 1998;97:1325–35. https://doi.org/10.1161/01.CIR.97.13.1325.
Reed RL, Siekert RG, Merideth J. Rarity of transient focal cerebral ischemia in cardiac dysrhythmia. JAMA. 1973;223(8):893–5. https://doi.org/10.1001/jama.1973.03220080025006.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Sacks, B., Budhdeo, S., Prossor, T., Vyas, V., Haider, S. (2024). Sudden Onset Focal Neurology: A Cardiac Cause. In: Gill, S.K., Brown, M., Robertson, F., Losseff, N. (eds) Stroke Medicine. Springer, Cham. https://doi.org/10.1007/978-3-031-58188-5_8
Download citation
DOI: https://doi.org/10.1007/978-3-031-58188-5_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-58187-8
Online ISBN: 978-3-031-58188-5
eBook Packages: MedicineMedicine (R0)