Brainstem Stroke in a Nigerian Male with Prosthetic Heart Valves—A Case Report

Stroke following cardiac surgery particularly valvular implantation is an anticipated complication. This is due to the prosthetic valve as well as possible associated comorbid conditions. There is dearth of published data on stroke post valve replacement surgery in Nigeria. There is no general consensus on the role of antiplatelet agents in combination with anticoagulant therapy in at-risk patients. Our paper documents the case of a 46-year-old male hypertensive, who in 2016 had mitral and aortic valve replacement surgery in a Tertiary Teaching Hospital and presented in May 2020 with sudden onset abnormal tongue sensation and double vision. A left internuclear ophthalmoplegia with bilateral torsional nystagmus was evident. Brain magnetic resonance imaging confirmed pontine lacunar infarction. There were no intracardiac clots on echocardiography. He had full resolution of deficits following treatment with anticoagulants. This case report demonstrates that ischemic stroke can occur in people with prosthetic heart valve and that other comorbid risk factors may be contributory. Anticoagulation therapy is important, though there is no consensus on time of starting therapy and the role of adjunctive antiplatelet combination therapy in such patients. Individualized therapy should be based on the type of implant, numbers, and location of valve replaced, comorbid clinical conditions, and the risk of hemorrhagic transformation.