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Recurrent strokes in the setting of anomalous left coronary artery from the pulmonary artery
  1. Ayesha Vos1,
  2. Kevin Rajakariar2,
  3. Pakeeran Siriratnam3,4 and
  4. Melanie Freeman2,3
  1. 1Department of Neurology, Eastern Health, Box Hill, Victoria, Australia
  2. 2Department of Cardiology, Eastern Health, Box Hill, Victoria, Australia
  3. 3Faculty of Medicine, Nursing and Health Sciences, Monash University Eastern Health Clinical School, Box Hill, Victoria, Australia
  4. 4Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
  1. Correspondence to Dr Pakeeran Siriratnam; p.siriratnam{at}


A young woman presented with a syncopal episode. As part of the work-up for her presentation, an MRI of the brain was performed which showed a small acute stroke. She subsequently had a further embolic-appearing stroke 9 months later. The initial investigations for the work-up of her strokes did not reveal any major abnormalities, including an unremarkable ECG and transthoracic echocardiogram (TTE). A transoesophageal echocardiogram (TOE) showed aneurysmal apical and mid-anteroseptal akinesis with mildly reduced left ventricular ejection fraction. Anomalous left coronary artery from the pulmonary artery (ALCAPA) was confirmed on coronary angiogram. Although ALCAPA presenting in adulthood is rare, our case highlights the value of TOE over TTE in the work-up of cryptogenic strokes, particularly in young patients with embolic strokes of undetermined source.

  • Neurology
  • Stroke

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: AV, KR, PS and MF. The following authors gave final approval of the manuscript: AV, KR, PS and MF.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.