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Transient ischemic attacks caused by trumpet playing

S Evers1, H Henningsen, E B Ringelstein

  • 1Department of Neurology, University of Münster, Germany. everss@uni-muenster.de

Neurology
|December 17, 1998
PubMed
Summary

A young musician experienced transient ischemic attacks (TIAs) while playing the trumpet, linked to a patent foramen ovale. Closing this heart defect resolved the TIAs and prevented further embolic signals.

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Area of Science:

  • Cardiology
  • Neurology
  • Cardiovascular Surgery

Background:

  • Transient ischemic attacks (TIAs) are serious warning signs of stroke.
  • Certain activities, like playing a wind instrument, can increase intrathoracic pressure and potentially trigger paradoxical embolism in individuals with cardiac shunts.

Observation:

  • A young musician presented with recurrent TIAs specifically during trumpet playing.
  • Cardiovascular evaluation identified a patent foramen ovale (PFO).
  • Cerebral Doppler ultrasound revealed microembolic signals during trumpet playing and Valsalva maneuvers, indicating potential for clot passage from the venous to arterial circulation.

Findings:

  • The patent foramen ovale was confirmed as the likely source of emboli causing TIAs.
  • Operative closure of the PFO effectively eliminated the microembolic signals.

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  • Post-procedure, the patient remained symptom-free, demonstrating the efficacy of the intervention.

    • Implications:

    • This case highlights the importance of considering paradoxical embolism in young individuals experiencing unexplained TIAs, especially with activities that induce pressure changes.
    • Transcatheter or surgical PFO closure is a viable treatment option for preventing recurrent TIAs in selected patients.
    • Understanding the link between specific maneuvers (trumpet playing, Valsalva) and embolic events can aid in diagnosis and management.