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Large Left Atrial Appendage Causing Cryptogenic Stroke

Michael Cinelli1, Mahmoud Shadi1, Sherif El-Hosseiny2

  • 1Internal Medicine, Staten Island University Hospital, Staten Island, USA.

Cureus
|December 7, 2019
PubMed

Insights

A large left atrial appendage (LAA) may contribute to cryptogenic stroke, even after atrial septal defect (ASD) repair. Further research is needed to establish anticoagulation guidelines for patients with large LAAs.

Area of Science:

  • Cardiology
  • Neurology
  • Vascular Medicine

Background:

  • Cryptogenic stroke, accounting for 25% of ischemic strokes, often lacks an identifiable cause.
  • Structural cardiac abnormalities like patent foramen ovale, atrial septal defects (ASD), and large left atrial appendages (LAA) are recognized risk factors.
  • The role of LAA in cryptogenic stroke pathogenesis requires further elucidation.

Observation:

  • A case study involving a patient with a history of surgically repaired ASD presented with acute cryptogenic stroke.
  • Diagnostic evaluations, including transthoracic echocardiogram and transesophageal echocardiogram, revealed a large LAA.
  • No thrombus was identified within the LAA, and no arrhythmias were detected in the patient.

Findings:

  • The presence of a large LAA, even without detectable thrombus, is highlighted as a potential contributor to cryptogenic stroke.
  • This case underscores the significance of the LAA in the development of cryptogenic strokes, particularly in patients with pre-existing cardiac conditions.

Implications:

  • Emphasizes the need to consider the LAA as a significant factor in cryptogenic stroke etiology.
  • Suggests a potential need for revised or clearer clinical guidelines regarding anticoagulation therapy in patients with large LAAs and cryptogenic stroke.

Keywords:
congenital anomalycryptogenic strokeleft atrial appendagestructural heart disease

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