case_images: PMC11830126_01
case_images: Brain MRI showing ischemic lesion in the left posterior lenticulocapsular region irrigated by the left thalamocapsular arteries
case_images: cureus-0017-00000077572-i01.jpg
case_images: PMC11830126_01_cureus-0017-00000077572-i01.jpg
case_images: FIG1
case_images: A cranial magnetic resonance imaging (MRI) was performed confirming an acute lesion in the left posterior lenticulocapsular region irrigated by the left thalamocapsular arteries, and scattered lesions were also described in the subcortical and peri-ventricular white matter with a predominance in the bilateral frontal regions, suggestive of chronic ischemic microvascular etiology (Figure 1).
case_images: Cervical Doppler showing no relevant changes
case_images: cureus-0017-00000077572-i02.jpg
case_images: PMC11830126_01_cureus-0017-00000077572-i02.jpg
case_images: FIG2
case_images: A1298C variant, but with normal homocysteine levels, meaning there was no increase in thrombotic risk. A Doppler of the neck vessels and 24-hour Holter monitoring were performed without significant changes (Figure 2).
case_images: Transthoracic echocardiogram showing hypertrabeculation in the apical region of the left ventricle
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case_images: PMC11830126_01_cureus-0017-00000077572-i03.jpg
case_images: FIG3
case_images: To complete the study, a transthoracic echocardiogram was also performed, which documented a very trabeculated left ventricle in the apical region, with slight concentric hypertrophy of the ventricular walls and an ejection fraction at the lower limit of normal (~ 50% using the Simpson Biplane method) (Figure 3). 