Cardiogenic cerebral embolism caused by transthyretin cardiac amyloidosis diagnosed by ^99mTc myocardial pyrophosphate scintigraphy. A case report

An 82-year-old man with a history of spinal stenosis and no significant family history presented with altered consciousness (JCS-II-30), left spatial neglect, conjugate deviation to the right, dysarthria, and left-sided facial hemiplegia. Head MRI revealed acute cerebral infarction in the posterior branch of the right MCA area, and an MRA revealed an occlusion in the right M2 posterior branch. Electrocardiography revealed atrial fibrillation, transthoracic echocardiography revealed severe diastolic dysfunction with apical sparing, and ^99mTc myocardial pyrophosphate scintigraphy indicated Grade 3 uptake by the heart. Cardiac amyloidosis, complicated by a cardiogenic cerebral embolism, was diagnosed. ATTR cardiac amyloidosis may coexist with cardiogenic cerebral embolism, and thus, a thorough examination should be conducted while considering ATTR cardiac amyloidosis. (author)