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Acute paradoxical embolic cerebral ischemia secondary to possible May-Thurner syndrome and an atrial septal defect: a case report.

Rison RA, Helfgott MD - J Med Case Rep (2013)

Bottom Line: May-Thurner syndrome is an anatomic abnormality that predisposes patients to increased risk of paradoxical embolism and stroke.It consists of chronic compression of the left common iliac vein by the overlying right common iliac artery which may predispose to local thrombus formation, which in turn may be the nidus of a paradoxical embolus leading to cerebral ischemia in patients with a right-to-left shunt secondary to an atrial septal defect or patent foramen ovale.We report the case of an embolic cerebral ischemic event in a 53-year-old Caucasian woman whose investigations revealed findings suggestive of possible May-Thurner syndrome coupled with an atrial septal defect.

View Article: PubMed Central - HTML - PubMed

Affiliation: Los Angeles County Medical Center, PIH Health Stroke Program, University of Southern California Keck School of Medicine, 12401 Washington Blvd,, Whittier, CA 90602, USA. rison@usc.edu.

ABSTRACT

Introduction: May-Thurner syndrome is an anatomic abnormality that predisposes patients to increased risk of paradoxical embolism and stroke. It consists of chronic compression of the left common iliac vein by the overlying right common iliac artery which may predispose to local thrombus formation, which in turn may be the nidus of a paradoxical embolus leading to cerebral ischemia in patients with a right-to-left shunt secondary to an atrial septal defect or patent foramen ovale.

Case presentation: We report the case of an embolic cerebral ischemic event in a 53-year-old Caucasian woman whose investigations revealed findings suggestive of possible May-Thurner syndrome coupled with an atrial septal defect. Her atrial septal defect was closed, she was placed on aspirin therapy, and has not had any recurrent events.

Conclusion: May-Thurner syndrome is an important consideration in patients with paradoxical embolic cerebral ischemia and atrial septal defects.

No MeSH data available.


Related in: MedlinePlus

Diffusion-weighted magnetic resonance imaging demonstrating an acute ischemic infarct within the mid left temporal lobe.
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Figure 1: Diffusion-weighted magnetic resonance imaging demonstrating an acute ischemic infarct within the mid left temporal lobe.

Mentions: Radiologic and sonographic investigations included an emergency head computed tomography (CT) scan, which was unremarkable. Subsequent magnetic resonance imaging (MRI) of the brain was performed and revealed an acute left parietal operculum ischemic infarct with mid left temporal lobe involvement (FigureĀ 1) and findings suggestive of recent embolic infarcts in the centrum semiovale bilaterally. Carotid duplex imaging showed a less than 30% stenosis of the bilateral carotid arteries and transcranial Doppler studies were within normal limits. Magnetic resonance angiography (MRA) of the neck revealed a focal 2cm region of fusiform aneurysmal dilatation of the right subclavian artery along with a focal fusiform dilatation of the left brachiocephalic vein in the supraclavicular fossa with a diameter of approximately 1.1cm. MRA of the brain revealed a within normal limits intracranial circulation pattern. A chest X-ray did not reveal any acute cardiopulmonary disease.


Acute paradoxical embolic cerebral ischemia secondary to possible May-Thurner syndrome and an atrial septal defect: a case report.

Rison RA, Helfgott MD - J Med Case Rep (2013)

Diffusion-weighted magnetic resonance imaging demonstrating an acute ischemic infarct within the mid left temporal lobe.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750277&req=5

Figure 1: Diffusion-weighted magnetic resonance imaging demonstrating an acute ischemic infarct within the mid left temporal lobe.
Mentions: Radiologic and sonographic investigations included an emergency head computed tomography (CT) scan, which was unremarkable. Subsequent magnetic resonance imaging (MRI) of the brain was performed and revealed an acute left parietal operculum ischemic infarct with mid left temporal lobe involvement (FigureĀ 1) and findings suggestive of recent embolic infarcts in the centrum semiovale bilaterally. Carotid duplex imaging showed a less than 30% stenosis of the bilateral carotid arteries and transcranial Doppler studies were within normal limits. Magnetic resonance angiography (MRA) of the neck revealed a focal 2cm region of fusiform aneurysmal dilatation of the right subclavian artery along with a focal fusiform dilatation of the left brachiocephalic vein in the supraclavicular fossa with a diameter of approximately 1.1cm. MRA of the brain revealed a within normal limits intracranial circulation pattern. A chest X-ray did not reveal any acute cardiopulmonary disease.

Bottom Line: May-Thurner syndrome is an anatomic abnormality that predisposes patients to increased risk of paradoxical embolism and stroke.It consists of chronic compression of the left common iliac vein by the overlying right common iliac artery which may predispose to local thrombus formation, which in turn may be the nidus of a paradoxical embolus leading to cerebral ischemia in patients with a right-to-left shunt secondary to an atrial septal defect or patent foramen ovale.We report the case of an embolic cerebral ischemic event in a 53-year-old Caucasian woman whose investigations revealed findings suggestive of possible May-Thurner syndrome coupled with an atrial septal defect.

View Article: PubMed Central - HTML - PubMed

Affiliation: Los Angeles County Medical Center, PIH Health Stroke Program, University of Southern California Keck School of Medicine, 12401 Washington Blvd,, Whittier, CA 90602, USA. rison@usc.edu.

ABSTRACT

Introduction: May-Thurner syndrome is an anatomic abnormality that predisposes patients to increased risk of paradoxical embolism and stroke. It consists of chronic compression of the left common iliac vein by the overlying right common iliac artery which may predispose to local thrombus formation, which in turn may be the nidus of a paradoxical embolus leading to cerebral ischemia in patients with a right-to-left shunt secondary to an atrial septal defect or patent foramen ovale.

Case presentation: We report the case of an embolic cerebral ischemic event in a 53-year-old Caucasian woman whose investigations revealed findings suggestive of possible May-Thurner syndrome coupled with an atrial septal defect. Her atrial septal defect was closed, she was placed on aspirin therapy, and has not had any recurrent events.

Conclusion: May-Thurner syndrome is an important consideration in patients with paradoxical embolic cerebral ischemia and atrial septal defects.

No MeSH data available.


Related in: MedlinePlus