Septyczne zatory mózgowe z powodu niepourazowej przetoki przedsionka-przełyku: opis przypadku

Abstract Background Nontraumatic atrioesophageal fistula (AEF) is an exceedingly rare and usually fatal communication between the esophagus and the left atrium. Neurological symptoms may dominate its presentation, yet they are easily attributed to more common causes. Case presentation: A 48-year-old man with epilepsy, heavy alcohol use and six months of progressive dysphagia — evaluated once by a normal otolaryngological examination four weeks earlier but not further investigated — was brought to the emergency department after being found at home confused and disoriented, with septic shock and upper gastrointestinal bleeding; no seizure activity had been witnessed, although an unwitnessed epileptic seizure could not be excluded. Initial non-contrast head CT was unremarkable, and the presentation was attributed to a possible postictal state in the context of septic-metabolic encephalopathy. The following day, new gaze deviation, central facial palsy, severe hemiparesis and tactile neglect on the left prompted repeat imaging. CT showed a new left thalamic lesion, and CT angiography revealed a gas-containing embolus at the left carotid bifurcation. These findings led to reassessment of the echocardiographic and thoracic findings and to the diagnosis of a left-sided AEF. Despite emergency embolectomy and atrial wall repair, a further ischemic lesion appeared in the right parietal region one week after surgery, and the patient died on postoperative day 10; biopsy confirmed esophageal squamous cell carcinoma. Conclusions Septic embolism from an occult AEF can present as a stroke mimic or be masked by postictal and septic-metabolic explanations. Evolving focal deficits warrant early neurological consultation, vascular imaging and reassessment of earlier findings, even when initial imaging is negative.