Atrial Fibrillation After Spontaneous Intracerebral Hemorrhage

Abstract

Introduction: Cardiac arrhythmias often occur during the acute phase of a stroke and can cause hemodynamic instability and sudden cardiac death. Data regarding determinants and the course of arrhythmia onset in the acute phase of stroke are still rare, especially in hemorrhagic stroke. Case report: A male, 74 years old, came to the emergency department with a complaint of weakness in the left hand and leg that had occurred suddenly 5 hours previously. Weakness is described by the left arm and leg still being able to be lifted a few seconds later and falling again. This complaint was accompanied by lips that appear pursed and severe dysarthria. The patient was said to have had a history of uncontrolled hypertension for 10 years. A previous history of heart disease was denied. A CT scan of the head without contrast showed intracerebral hemorrhage in the basal ganglia and right external capsule with a volume of 5 cc. An electrocardiography (ECG) examination showed sinus rhythm without any indication of heart rhythm disturbances. Further ECG examination after the 4th day of hospitalization showed atrial fibrillation with rapid ventricular response (AFRVR). The patient eventually died one day after the heart rhythm changed. Discussion: The incidence of AF varies depending on the type of stroke that occurred, the monitoring device used, the interval between initial monitoring and stroke onset, and the duration of cardiac monitoring. AF in patients can occur as a result of a hemorrhagic stroke, but it is also possible because of the presence of previously undetected paroxysmal AF. High NIHSS correlates with system disturbances in autonomous cardiovascular systems. According to current NIHSS measurements, hospital admission is required as a parameter for heart rhythm monitoring for more than 24 hours. Conclusion: Newly detected AF after ICH greatly influences the clinical outcome of patients. Understanding the mechanism and pathophysiology of new AF after ICH will contribute to a better understanding of the management of the patient. Keywords: atrial fibrillation, cardiac arrhythmia, case report, stroke, intracerebral hemorrhage