Stroke secondary to hip ulcer and Septic emboli

Strokes are frequently seen in older patients mainly due to long standing hypertension, diabetes mellitus and hyper cholesterolemia. It is not common in younger adults especially when there is no obvious cause. The workup to find the cause is often difficult in such cases.

Case Description

A 38-year-old paraplegic male presented in Emergency Department with the complaints of fever, headache, haematuria and awaiting closure of left hip wound; however, it seemed non infected. Regarding his medical history, he had ASD associated with pulmonary hypertension and type 1 diabetes mellitus. Besides, after 24hrs of admission he developed right sided neglect. On examination, he was febrile with increased heart rate and respiratory rate. Moreover, he had right homonymous hemianopia and NIHSS score was 3. CT PA was done to rule out pulmonary embolism. Additionally, CT CAP and CT head showed splenic infarct and occipital infarct, respectively. Therefore, a diagnosis of paradoxical embolus was made and treated accordingly. Later, blood culture revealed beta haemolytic streptococci and the underlying cause of septic stroke was thought to be hip ulcer extending to bone. This was followed by CT pelvis, on which bone destruction was seen. Therefore, antibiotics were commenced and left hemiarthoplasty was done.

This case illustrate that in younger population, often soft tissue and bone infection can lead to pro-thrombotic events resulting into septic emboli, a potential cause of stroke (especially when accompanied by ASD). Early assessment and management is valuable as it can lead to serious complications and increased morbidity.