Ischemic stroke in a young patient with cardioembolic etiology: clinical case report and contextual review

Abstract

Ischemic stroke in young patients, particularly women without comorbidities, is an uncommon but increasingly relevant clinical presentation. We report the case of an 18-year-old female patient in Cochabamba, Bolivia, with no prior medical history, who presented with right-sided hemiparesis, aphasia, and sudden loss of consciousness. Brain CT revealed a large hypodense area in the left occipito-parietal region (75x50x40 mm), consistent with ischemic edema without hemorrhage or midline shift. Brain MRI showed focal hyperintensity in the left MCA territory on DWI, indicating restricted diffusion; T2 images revealed diffuse hypointensity and loss of cortico-subcortical differentiation, compatible with subacute ischemic injury. Angio-MRI demonstrated focal hypoperfusion and reduced arterial caliber. Transesophageal echocardiography identified mitral valve vegetation and intracavitary thrombi, suggesting a cardioembolic etiology. Despite intensive ICU management, the clinical course was unfavorable, with progressive hypoxic encephalopathy. Wake EEG showed persistent bilateral flat tracing with no cortical activity or stimulus response, confirming brain death. This case illustrates a fulminant form of juvenile stroke, emphasizing the importance of early comprehensive evaluation with advanced neuroimaging and coordinated multidisciplinary care.