Acute ischemic stroke (AIS) and Acute Myocardial Infarction (AMI) are well recognized clinical entities with established management algorithms. However simultaneous cardio-cerebral infarction (CCI) is an exceedingly rare phenomenon with grave prognosis. Here, we present a case report and the literature available on managing such complex presentations.

A 52-year-old African American male was brought to the emergency department with acute onset left hemiparesis, spastic dysarthria, right gaze preference and concurrent chest pain. En route to the hospital patient received aspirin and sublingual nitroglycerine. On arrival, his National Institute of Health Stroke Scale (NIHSS) was 26 with antero-septal ST segment elevation consistent with AMI.  He was hypertensive on arrival with BP as 150/90. Computed tomography (CT) of the brain revealed acute ischemic stroke in right- middle cerebral artery territory. CT angiogram showed occlusion of cervical segment of right Internal Carotid Artery. Troponin was elevated at 0.19. Patient was not a candidate for tissue plasminogen activator for he presented 4.5 hours after symptom onset. Given risk of hemorrhagic transformation of AIS associated with Percutaneous Coronary Intervention (PCI), it was decided to conservatively manage AMI with aspirin and statin.

Management of simultaneous CCI continues to be a challenging task for physicians. So far eight cases of simultaneous CCI have been reported. Both AIS and AMI have a narrow therapeutic time-window, such that acute management of one at the expense of the other may result in permanent irreversible disability from the infarcted area that received delayed intervention. American Heart Association/ American Stroke Association (AHA/ASA) recommends treatment with intravenous alteplase at dose appropriate for AIS followed by Percutaneous Coronary Angiography and stenting. However given the rarity of simultaneous CCI, guidelines regarding optimal management of this medical emergency are still unclear and needs further investigation.