Dissecting the Delirium: A Case of Triple Vessel SCAD Secondary to Encephalitis

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Spontaneous coronary artery dissection (SCAD) and viral encephalitis (n=1). Intervention: Percutaneous coronary intervention. Primary outcome: Freedom from cardiac events.

Q: What does this research mean for the field?

Presumed viral encephalitis can trigger severe multivessel spontaneous coronary artery dissection, which can be successfully managed with emergent percutaneous coronary intervention leading to favorable long-term outcomes. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Katie Doyle; Patrick Savage; Paul Johnston

doi:10.1155/cric/4183983

January 1, 2026Case Reports in CardiologyOpen Access

Dissecting the Delirium: A Case of Triple Vessel SCAD Secondary to Encephalitis

View Full Paper

Ask AI

Bookmark

Share

Figures

Why the study?

Spontaneous coronary artery dissection (SCAD) is an infrequently diagnosed cause of ACS with often no clear precipitant identified, and novel presentations require characterization.

Key Points

To document an unusual presentation of triple vessel spontaneous coronary artery dissection (SCAD) in a patient presenting with presumed viral encephalitis.
Clinical evaluation, lumbar puncture, electroencephalogram (EEG), and brain MRI in a 61-year-old female presenting with headache, dysphasia, and confusion.
Serial coronary angiography following posterior myocardial infarction to evaluate multivessel disease.
Percutaneous coronary intervention utilizing drug-eluting stents and a 'shotgun' left main stem bifurcation strategy following clinical deterioration, with nearly 10 years of follow-up.
Initial coronary angiography revealed Type 1 SCAD in the right coronary artery and diffuse Type 2b lesions in both the left anterior descending and circumflex arteries.
Clinical deterioration 4 days later revealed an occluded right coronary artery treated with three overlapping drug-eluting stents, followed by flow-limiting dissection extending to the left main stem treated via simultaneous kissing stents.
The patient experienced full resolution of neurological impairment and remained free of cardiac events over nearly 10 years of follow-up.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 61-year-old female presenting with presumed viral encephalitis who subsequently developed triple-vessel spontaneous coronary artery dissection, followed for nearly 10 years.

I

Intervention

Percutaneous coronary intervention (PCI) including treatment of the right coronary artery with three overlapping drug-eluting stents, and treatment of the left main stem bifurcation using a simultaneous kissing stent 'shotgun' technique for the LAD and LCx, and a T and crush technique for the diagonal.

O

Outcome

Clinical course, resolution of symptoms, and freedom from cardiac eventshard clinical

Limitations

Diagnostic ambiguity due to inconclusive MRI head findings.
Presence of other possible contributory factors for SCAD such as severe agitation, autonomic activation, and catecholamine surge.
Diagnostic ambiguity regarding encephalitis due to inconclusive MRI head findings degraded by movement artefact.
Inability to definitively exclude other contributory factors and precipitants for SCAD such as severe agitation, autonomic activation, and catecholamine surge.

Implication

This case highlights viral encephalitis as a novel potential precipitant for triple vessel spontaneous coronary artery dissection (SCAD) and demonstrates the successful use of emergent complex percutaneous coronary intervention as a salvage strategy.

Abstract

Spontaneous coronary artery dissection (SCAD) is an infrequently diagnosed cause of an acute coronary syndrome (ACS). In many cases, no clear precipitant is identified. In this case, we present a novel presentation of triple vessel SCAD in a patient presenting with viral encephalitis. Despite an initial conservative strategy, haemodynamic instability and involvement of the left main stem (LMS) ultimately necessitated emergent coronary intervention with a 'shotgun' LMS bifurcation strategy.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Doyle et al. (2026) conducted a case report in Spontaneous coronary artery dissection (SCAD) and viral encephalitis (n=1). Percutaneous coronary intervention was evaluated on Freedom from cardiac events.

synapsesocial.com/papers/6ad0fcc53afa093ea9acffae https://doi.org/10.1155/cric/4183983

View Full Paper

Ask AI

Bookmark

Share

Dissecting the Delirium: A Case of Triple Vessel SCAD Secondary to Encephalitis

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Dissecting the Delirium: A Case of Triple Vessel SCAD Secondary to Encephalitis

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading