# Ischemic Stroke as an Initial Manifestation of Silent, Evolved Myocardial Infarction: A Case Report

## TL;DR

A man with no chest pain was found to have a silent heart attack that caused a stroke, highlighting the need for careful diagnosis and personalized care.

## Contribution

This case report highlights the rare scenario where stroke is the first sign of a silent, evolved heart attack.

## Key findings

- A patient with sudden neurological deficits was found to have a silent ST-elevation myocardial infarction.
- Repeat imaging showed a recent ischemic infarct, linking the stroke to the undiagnosed heart attack.
- Multidisciplinary care was essential in managing this complex case.

## Abstract

Acute ischemic stroke (AIS) is a rare initial manifestation of silent, evolved myocardial infarction (MI). AIS presents significant diagnostic and therapeutic challenges, particularly in patients with multiple comorbidities. Herein, we report a 64-year-old male patient with a history of hypertension and type 2 diabetes, who was admitted due to sudden neurological deficits without chest pain. The initial workup revealed an Alberta Stroke Program Early CT Score (ASPECTS) of 10/10 and no hypodense areas. Further investigations showed an ST-elevation MI without typical symptoms, indicating that a silent, evolved MI was the underlying cause. The 24-hour repeat head CT scan revealed a recent right lenticuloradial ischemic infarct. Multidisciplinary management focused on risk stratification, balancing antithrombotic therapy, and initiating early rehabilitation. This case emphasizes the importance of considering silent MI in AIS of unclear etiology and the need for individualized, multidisciplinary care.