T-wave Inversions in Cerebellar and Occipital Lobe Infarcts in the Setting of Deep Vein Thrombosis and Pulmonary Embolism Suggestive of Paradoxical Emboli: A Case Report

• Published in: Curēus (Palo Alto, CA) Vol. 14; no. 4; p. e24230
• Main Authors: Alshamam, Mohsen S, Nso, Nso, Nassar, Mahmoud, Idrees, Zarwa, Ghernautan, Victoria, Khan, Saifullah, Abdalazeem, Yousef, Munira, Most
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 18-04-2022; Cureus
• Subjects: Anticoagulants; Cardiac arrhythmia; Cardiology; Cardiovascular disease; Case reports; Coronaviruses; COVID-19 vaccines; Electrocardiography; Influenza; Internal Medicine; Laboratories; Neurology; Patients; Peptides; Pulmonary arteries; Pulmonary embolisms; Sinuses; Thrombosis; Tomography; Ultrasonic imaging; Vomiting; cardio vascular disease; brain infarcts; deep vein thrombosis (dvt); case report; acute pulmonary embolism; acute cva; t-wave inversion
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.24230

Cardiological causes account for the majority of acute electrocardiographic (ECG) changes. The reason for this fear is the irreversibility of myocardial necrosis. Generally, various changes can be observed in the ECG, including ST-T changes, QTc prolongation, arrhythmias, and T-wave inversions. Even though T-wave inversions can be seen in myocardial ischemia/infarction, they are rarely seen in acute cerebrovascular accidents (CVAs). We present the case of a 66-year-old woman who initially presented at our facility with dizziness in the context of orthostatic hypotension. An initial cardiac evaluation revealed no cardiac involvement. She was treated with intravenous fluids (IVF), which improved her symptoms. The patient's mental status was markedly altered approximately four days after admission. In this instance, she was found to have abnormal ECG findings (not previously observed on the ECG that was obtained on the day of admission), elevated troponin T levels, as well as elevated pro-B-type natriuretic peptide (pro-BNP). The patient was given aspirin and clopidogrel immediately and was placed on a heparin drip for a suspected non-ST elevation myocardial infarction (NSTEMI). A non-contrast computed tomography of the head revealed an acute cerebrovascular accident (CVA), following which the heparin drip was stopped. The patient was then transferred to another acute care facility capable of performing neurosurgical interventions. Additionally, a computed tomography angiography (CTA) of the chest and lower extremities venous duplex showed bilateral pulmonary emboli and deep venous thrombosis (DVT), respectively.