Cardio-cerebral infarction syndrome across the acute care spectrum: A four-case series highlighting diagnostic complexity and reperfusion strategy

Cardio-cerebral infarction syndrome (CCIS) represents a rare but clinically challenging overlap of acute ischemic stroke (AIS) and acute myocardial infarction (AMI), where competing priorities of reperfusion create therapeutic dilemmas. We report a four-patient case series illustrating the clinical spectrum, imaging characteristics, and management strategies of CCIS encountered in the emergency setting. Two patients presented with concurrent AIS and AMI (Type 1), one developed AMI following recent stroke (Type 3), and one presented with stroke after myocardial infarction (Type 2). Neuroimaging demonstrated varied infarct patterns including gangliocapsular, pontine, multifocal cortical, and lacunar infarctions, while cardiac evaluation revealed reduced left ventricular ejection fraction (30%–45%) with predominant left anterior descending artery involvement. Management strategies were individualized based on hemodynamic stability and infarction chronology, including intravenous Alteplase followed by percutaneous coronary intervention (PCI) in stable patients and primary PCI in unstable cases. Early multidisciplinary decision-making enabled timely reperfusion without major complications, and all patients were discharged with favourable clinical outcomes on dual antiplatelet therapy. This case series highlights the importance of early recognition, simultaneous neuro-cardiac evaluation, and tailored reperfusion sequencing in optimizing outcomes in CCIS.