Synchronous Cardio Cerebral Infarction following Leptospirosis: a management challenge

Abstract

Cardio cerebral infarction (CCI), a rare condition involving the simultaneous or sequential occurrence of acute ischemic stroke and acute myocardial infarction, presents as a clinical conundrum to physicians. Though leptospirosis is an endemic disease, clear guidelines on similar atypical presentations are lacking. A 56-year-old male, managed as leptospirosis (improved with antibiotics) with uneventful recovery, had deteriorated sub acutely with slurred speech and limb weakness after discharge. Then he was diagnosed with non-ST elevation myocardial infarction with heart failure with mildly reduced ejection fraction and simultaneous right-sided parietal and left-sided frontoparietal infarctions. Despite treatment with dual antiplatelets and supportive care, he deteriorated and eventually went into cardiac arrest. CCI involves complex pathophysiology related to thrombotic events, inflammatory responses, endothelial dysfunction, plaque rupture, and cardiogenic embolism, which can exacerbate cardio-cerebral events. This case highlights the unique clinical dilemmas met during the management of CCI in the context of leptospirosis. It’s better for clinicians to have heightened awareness and clinical vigilance to diagnose CCIs earlier and initiate multi-disciplinary approaches for favorable outcomes. Preventive strategies are still a matter of evolving research.