# Isolated Callosal Infarction Associated With Left Ventricular Thrombus in the Absence of Documented Atrial Fibrillation: A Case Report

## TL;DR

A man with a rare type of stroke involving the corpus callosum was found to have a heart clot despite no signs of atrial fibrillation, highlighting the need for thorough cardiac evaluation.

## Contribution

This case report highlights left ventricular thrombus as a potential cardioembolic source for callosal infarction without atrial fibrillation.

## Key findings

- Isolated corpus callosum infarction was confirmed via MRI without cortical involvement.
- A left ventricular thrombus was identified as a possible embolic source despite no atrial fibrillation detected.
- The patient showed neurological improvement with anticoagulation and multidisciplinary care.

## Abstract

Isolated corpus callosum infarction is an uncommon subtype of ischemic stroke and may be diagnostically challenging because of its atypical clinical presentation and variable clinicoradiologic correlation. We report the case of a 43-year-old Filipino male with poorly controlled hypertension who presented with sudden-onset right-sided weakness, expressive language impairment, and disorientation. On admission, the patient had a National Institutes of Health Stroke Scale score of 10. Neurologic examination revealed right central facial palsy, right hemiparesis, dysarthria, and cognitive impairment. Brain magnetic resonance imaging demonstrated acute ischemic lesions involving the body and splenium of the corpus callosum without definite cortical infarction. Extracranial vascular imaging showed no significant stenosis. Cardiac evaluation revealed a hypokinetic left ventricle with reduced ejection fraction and an apical thrombus, while continuous inpatient monitoring and 24-hour Holter electrocardiography did not demonstrate atrial fibrillation during hospitalization. The patient was managed with therapeutic anticoagulation, high-intensity statin therapy, optimization of antihypertensive treatment, and early multidisciplinary rehabilitation, resulting in meaningful neurological and functional improvement. This case illustrates the diagnostic complexity of callosal infarction and supports consideration of left ventricular thrombus as a clinically significant cardioembolic source, even when atrial fibrillation is not detected at initial presentation.