Conservative Approach in Simultaneous Cardio-cerebral Infarction – A Case Series

Cardio-cerebral infarction (CCI), or the concurrent occurrence of acute ischemic stroke and acute myocardial infarction, is a rare medical emergency. There is a paucity of high-quality data on management, and due to the condition’s rarity, a clinical trial is logistically challenging. Current treatment strategies are based on previously reported cases that were successfully managed. Our case series describes the epidemiology, risk factors, and clinical outcomes of five patients presenting with simultaneous CCI. The sample was predominantly male with a median age of 64 years, and common cardiovascular risk factors were hypertension and diabetes mellitus. None presented with angina, and only one patient had an objective neurological deficit. We hypothesized the possible mechanisms to be mainly brain–heart axis dysregulation secondary to infarction in middle cerebral artery territory and reduced left ventricular ejection fraction. Although none of our patients received reperfusion therapy during the index hospitalization, there was only one inhospital death; two died 3 months after the primary event, and two survived with good functional outcomes. Multiple factors such as premorbid state, National Institute of Health Stroke Scale score, and severity of cardiac and cerebral ischemia were linked to the clinical outcome; this further emphasizes the need for individualization of treatment.