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Dilated cardiomyopathy-related stroke mimicking large-artery atherosclerosis-related stroke: report of two cases

  • Guozhen Qiu1,†
  • Lijie Ren2,3,†
  • Hongliang Jiang4
  • Xin Shi5
  • Liming Cao2,3

1Department of Neurology, The Third Affiliated Hospital of Shenzhen University, 518000 Shenzhen, Guangdong, China

2Department of Neurology, The First Affiliated Hospital of Shenzhen University, 518000 Shenzhen, Guangdong, China

3Department of Neurology, Shenzhen Second People's Hospital, 518000 Shenzhen, Guangdong, China

4Department of Neurology, The Third People's Hospital of Yiyang City, 413000 Yiyang,Hunan, China

5Business School, Manchester Metropolitan University, M15 6BH Manchester, UK

DOI: 10.22514/sv.2021.211 Vol.17,Issue 6,November 2021 pp.150-156

Submitted: 09 July 2021 Accepted: 13 August 2021

Published: 08 November 2021

*Corresponding Author(s): Liming Cao E-mail:

† These authors contributed equally.


The clinical characteristics and treatment of stroke caused by dilated cardiomyopathy (DCM) are not clear, especially in patients with large-artery atherosclerosis (LAA)-related stenosis, which commonly causes acute ischemic stroke (AIS); therefore, the diagnosis and treatment of such patients are challenging. Herein, we summarize the clinical characteristics and suggest clues to guide the diagnosis and treatment of two cases. Case 1: A 67-year-old woman with a history of DCM presented with sudden-onset slurred speech and left limb weakness (>2 hours duration), which worsened after intravenous thrombolysis. Repeated brain computed tomography showed no hemorrhage; thus, cerebral artery occlusion or embolism was suspected. Emergency magnetic resonance imaging (MRI) and angiography (MRA) revealed acute multiple bilateral cerebral infarctions and severe left middle cerebral artery stenosis, respectively. We considered a DCM-related stroke and administered anticoagulation therapy. Subsequently, the patient’s symptoms improved significantly, and she was discharged on day 9, after showing no abnormal neurological signs. Case 2: A 49-year-old man with a history of DCM presented with acute headache and blurred vision for 4 days. MRI and MRA revealed multiple acute cerebral infarctions and left vertebral artery stenosis, respectively. We considered an LAA-related stroke and administered antiplatelet and cholesterol-lowering drugs. Eventually, the patient was discharged on day 13, after his right-sided hemianopia improved significantly. Both patients had LAA, which can be easily misdiagnosed as a stroke. LAA-related and DCM-related stroke need to be differentiated. DCM-related AIS lesions are often distributed in the areas supplied by the different cerebral arteries. It is necessary to carefully analyze the shape, location, and scope of the lesions, and identify the main causes of stroke. Anticoagulant therapy is preferred for DCM-related AIS.


Dilated cardiomyopathy; Stroke; Large artery atherosclerosis; Anticoagulation therapy; Case report

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Guozhen Qiu,Lijie Ren,Hongliang Jiang,Xin Shi,Liming Cao. Dilated cardiomyopathy-related stroke mimicking large-artery atherosclerosis-related stroke: report of two cases. Signa Vitae. 2021. 17(6);150-156.


[1] Weintraub RG, Semsarian C, Macdonald P. Dilated cardiomyopathy. Lancet. 2017; 390: 400–414.

[2] Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006; 113: 1807–1816.

[3] Manolio TA, Baughman KL, Rodeheffer R, Pearson TA, Bristow JD, Michels VV, et al. Prevalence and etiology of idiopathic dilated cardiomyopathy (summary of a National Heart, Lung, and Blood Institute workshop. The American Journal of Cardiology. 1992; 69: 1458–1466.

[4] Taylor MRG, Carniel E, Mestroni L. Cardiomyopathy, familial dilated. Orphanet Journal of Rare Diseases. 2006; 1: 27.

[5] Arboix A, García-Eroles L, Massons J, Oliveres M. Predictive clinical factors of in-hospital mortality in 231 consecutive patients with cardioembolic cerebral infarction. Cerebrovascular Diseases. 1998; 8: 8–13.

[6] Zhdanova SG, Petrikov SS, Ramazanov GR, Khamidova LT, Aliev IS, Sarkisyan ZO. Dilated cardiomyopathy as a cause of ischemic stroke. Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova. 2016; 116: 44–47.

[7] Jeon GJ, Song BG, Park YH, Kang GH, Chun WJ, Oh JH. Acute Stroke and Limb Ischemia Secondary to Catastrophic Massive Intracardiac Thrombus in a 40-Year-Old Patient with Dilated Cardiomyopathy. Cardiology Research. 2012; 3: 37–40.

[8] Ho CH, Lin YY, Wu YC, Chu SJ, Tsai SH. Postictal confusion as the initial presentation of dilated cardiomyopathy: a case report and review of literatures. Journal of Internal Medicine of Taiwan. 2010; 21: 133–139.

[9] Karande SC, Kulthe SG, Lahiri KR, Jain MK. Embolic stroke in a child with idiopathic dilated cardiomyopathy. Journal of Postgraduate Medicine. 1996; 42: 84–86.

[10] Doğan M, Peker E, Cagan E, Akbayram S, Acikgoz M, Caksen H, et al. Stroke and dilated cardiomyopathy associated with celiac disease. World Journal of Gastroenterology. 2010; 16: 2302–2304.

[11] Yang J, Liao Y, Yuan J, Wang Z, Cheng X, Zhao D. Chinese guidelines for diagnosis and treatment of dilated cardiomayopathy. Journal of Clinical Cardiology. 2018; 34: 421–434. (In Chinese)

[12] Crawford TC, Smith WT, Velazquez EJ, Taylor SM, Jollis JG, Kisslo J. Prognostic usefulness of left ventricular thrombus by echocardiography in dilated cardiomyopathy in predicting stroke, transient ischemic attack, and death. The American Journal of Cardiology. 2004; 93: 500–503.

[13] Agarwal M, Apostolakis S, Lane DA, Lip GYH. The impact of heart failure and left ventricular dysfunction in predicting stroke, thromboem-bolism, and mortality in atrial fibrillation patients: a systematic review. Clinical Therapeutics. 2014; 36: 1135–1144.

[14] Arboix A, Alió J. Acute cardioembolic stroke: an update. Expert Review of Cardiovascular Therapy. 2011; 9: 367–379.

[15] Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europacey. 2016; 18: 1609–1678.

[16] Boursier-Bossy V, Zuber M, Emmerich J. Ischemic stroke and non-valvular atrial fibrillation: when to introduce anticoagulant therapy?JMV-Journal De MéDecine Vasculaire. 2020; 45: 72–80.

[17] Wang S, Ma F, Huang L, Zhang Y, Peng Y, Xing C, et al. Dl-3-n- Butylphthalide (NBP): a Promising Therapeutic Agent for Ischemic Stroke. CNS & Neurological Disorders Drug Targets. 2018; 17: 338–347.

[18] Chen X, Qiu K, Liu H, He Q, Bai J, Lu W. Application and prospects of butylphthalide for the treatment of neurologic diseases. Chinese Medical Journal. 2019; 132: 1467–1477.

[19] Kikuchi K, Miura N, Kawahara K, Murai Y, Morioka M, Lapchak PA, et al. Edaravone (Radicut), a free radical scavenger, is a potentially useful addition to thrombolytic therapy in patients with acute ischemic stroke. Biomedical Reports. 2013; 1: 7–12.

[20] Takenaka K, Kato M, Yamauti K, Hayashi K. Simultaneous administra-tion of recombinant tissue plasminogen activator and edaravone in acute cerebral ischemic stroke patients. Journal of Stroke and Cerebrovascular Diseases. 2014; 23: 2748–2752.

[21] Li F, Zhao L, Shi Y, Liang J. Edaravone-Loaded Macrophage-Derived Exosomes Enhance Neuroprotection in the Rat Permanent Middle Cerebral Artery Occlusion Model of Stroke. Molecular Pharmaceutics. 2020; 17: 3192–3201.

[22] Srinivasan K, Sharma SS. Edaravone offers neuroprotection in a diabetic stroke model via inhibition of endoplasmic reticulum stress. Basic & Clinical Pharmacology & Toxicology. 2012; 110: 133–140.

[23] Yang L, Zhao P, Zhao J, Wang J, Shi L, Wang X. Effects of ezetimibe and anticoagulant combined therapy on progressing stroke: a randomized, placebo-controlled study. Journal of Neurology. 2016; 263: 2438–2445.

[24] Inoue A, Kohno K, Iwata S, Ohue S, Ozaki S, Ninomiya S, et al. Efficacy of Early Superficial Temporal Artery-Middle Cerebral Artery Double Anastomoses for Atherosclerotic Occlusion in Patients with Progressing Stroke. Journal of Stroke and Cerebrovascular Diseases. 2017; 26: 741–748.

[25] Hayashi K, Matsuo Y, Toyoda K, Hayashi Y, Shirakawa K, Kaminogo M.[a Case of Vertebral Artery Stenosis Presenting with Progressing Stroke and Treated by Percutaneous Transluminal Angioplasty] no Shinkei Geka. Neurological Surgery. 2016; 44: 383–389.

[26] Tatu L, Moulin T, Bogousslavsky J, Duvernoy H. Arterial territories of the human brain: cerebral hemispheres. Neurology. 1998; 50: 1699–1708.

[27] Tatu L, Moulin T, Bogousslavsky J, Duvernoy H. Arterial territories of human brain. Neurology. 1996; 47: 1125–1135.

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