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A 47-year-old man had an acute ischemic stroke (IS); brain MRI revealed multiple silent old IS (figure 1A). A comprehensive workup, including prolonged cardiac monitoring (cumulated duration of 25 days) and cardiac transthoracic/transesophageal echography, was negative. Eleven months later, despite statin and aspirin therapy, a new symptomatic embolic IS of undetermined source occurred (figure 1B). Cardiac MRI1 revealed a left apical dyskinetic saccular evagination (figure 2, A–C) consistent with a congenital left ventricular diverticulum confirmed on left ventriculography (figure 2D) and the presumed source of recurrent embolic IS.2 No IS occurred after 30 months of warfarin therapy.

Recurrent cryptogenic stroke in young adult linked to congenital left ventricular diverticulum