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[Brain embolism associated with atrial septal aneurysm]
T Terasaki1, T Yonehara, S Fujioka
1Department of Neurology, Saiseikai Kumamoto Hospital.
Rinsho Shinkeigaku = Clinical Neurology
|February 1, 1997
Summary
Atrial septal aneurysm, often linked with right-to-left shunts, is a significant indicator for paradoxical embolism in ischemic stroke patients. This finding suggests a potential cause for brain embolism when other sources are ruled out.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Atrial septal aneurysm (ASA) is a rare condition.
- The association between ASA and cerebrovascular events remains under investigation.
- Identifying embolic sources is crucial for stroke management.
Purpose of the Study:
- To investigate the clinical significance of atrial septal aneurysm as a potential source of brain embolism.
- To explore the role of ASA in paradoxical embolism.
Main Methods:
- Retrospective analysis of 228 ischemic stroke patients.
- Transesophageal echocardiography (TEE) performed on 128 patients to identify cardiac embolic sources.
- Contrast echocardiography with Valsalva maneuver to detect right-to-left shunts.
- Brain CT, cerebral angiography, neurosonologic study, 24-hour Holter ECG, and transthoracic echocardiography were utilized.
Main Results:
- Three cases of ASA with right-to-left shunt were identified among patients with ischemic stroke.
- These three cases were diagnosed with brain embolism, with ASA and shunt being the only identified embolic source.
- Other potential embolic sources were excluded by comprehensive diagnostic workup.
- A paradoxical embolic mechanism was implicated in these cases.
Conclusions:
- Atrial septal aneurysm frequently coexists with right-to-left shunts.
- ASA is clinically significant and suggests a potential for paradoxical embolism.
- This finding is important for evaluating cryptogenic stroke and identifying uncommon embolic sources.