Stroke complicating penetrating heart injury: Keys to the diagnostic workup and management

Brain computed tomography (CT) scan showed the bilateral occipital and right frontal cortico-subcortical hypodensities [Figure 1]a and [Figure 1]b. Brain magnetic resonance imaging (MRI) performed shortly after the CT scan revealed the bilateral frontal and right occipital high-signal lesions in fluid-attenuated inversion recovery compatible with recent infarct on the diffusion-weighted imaging B1000 image [Figure 1]c and [Figure 1]d associated with the presence of microbleeds on T2-weighted image [Figure 1]e and [Figure 1]f. These imaging findings were suggestive of cardioembolism. Transesophageal echocardiography found neither intracavitary thrombus nor patent foramen ovale. The other minor cardiac sources of embolism are the following: patent foramen ovale, atrial septal aneurysm, atrial septal defects, and aortocaval fistula.