An Incidental Cause


A foreign engineer in his thirties presented to our department with acute left hemiplegia. He was recently well, and has no past medical history.


Vital signs: BP 184/136mmHg, PR 91, RR 17, SpO2: 100% on room air. NIHSS score is 4. An urgent CT head demonstrated small infarct in the right corona radiate region. A telestroke consult was initiated; the patient was offered and agreed to thrombolysis.


The routine screening ECG was rather concerning:



Prior to thrombolysis, however, the patient became dyspneic. Crackles developed over the patient’s lung bases. Bedside lung ultrasound showed multiple B lines, suggesting of an acute interstitial syndrome from pulmonary edema. Beside echo is performed, with image taken at maximum mitral valve excursion during diastole.

Did you see the cause of the patient’s stroke and pulmonary edema?

#Q

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