A 41-year-old farmer sustained a high-voltage electrical injury resulting in confusion, electrical burns and paroxysmal atrial fibrillation which spontaneously reverted to sinus rhythm after a few hours. Two weeks later he presented with a sudden onset of headache, unsteadiness, horizontal oscillopsia and paraesthesia in the right side of his face. Examination revealed nystagmus to the right, right-sided limb ataxia and a tendency to veer toward the right when walking. An MRI of the brain demonstrated an acute infarct of the right cerebellar hemisphere in the territory of the right posterior inferior cerebellar artery. A transesophageal echocardiogram showed a ruptured mitral valve chordae. This is the first report of a cardio-embolic stroke secondary to mitral valve chordae rupture as a delayed complication of high-voltage electrical injury. Although many mechanisms of direct cerebral electrical injury have been speculated, a cardio-embolic origin should not be overlooked as a cause of stroke secondary to high-voltage electrical injury.
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