Simultaneous onset of hemorrhagic and ischemic stroke in a patient: Case report

Abstract

Stroke is a disorder seen in fifteen million of the world population, however simultaneous onset of hemorrhagic and ischemic stroke is considered a very rare enigma. Precise risk factors and etiology contributing to the enigma is yet to be concealed. We hereby report a case of a 48-year-old female patient presented with headache and multiple unknown onset generalized tonic clonic seizure since 2 hours before admission and patient was unconscious since. History of uncontrolled hypertension was identified. Physical examination showed high blood pressure of 180/90 mmHg, GCS 6, downward gaze on both eyes, cranial nerve VII and XII palsy, with bilateral extremity weakness. ECG was normal and routine lab examination showed low potassium level, high LDL and high white blood cell count. Brain CT Scan revealed simultaneous acute intracerebral hemorrhage on the left thalamus with perifocal edema, and acute infarct on the left parieto-temporo-occipital lobe. Anticonvulsants together with antibiotics, osmotic diuretic and tranexamic acid was introduced during hospitalization, despite no intensive care facility was available. Patient passed away the day after regardless of the given treatment. Simultaneous onset of hemorrhagic and ischemic stroke undeniably has a poor prognosis. Studies with abundant samples are needed to investigate the risk factors contributing to this condition, which can evidently lead to increase prevention of this scanty phenomena.