Strokes: A complication of mitral-leaflet prolapse?
During a prospective trial of platelet-inhibiting drugs in patients with transient ischaemic attacks (T.I.A.s), 14 patients had serious neurological dysfunction and normal cerebral angiograms. The patients (mean age 37 years) had neurological episodes over a period of 1-4 years consisting of acute non-progressive strokes with residual symptoms. In 3 patients, the two cerebral hemispheres were involved on different occasions. Cerebral angiograms showed no significant atheromatous disease in the intracranial or extracranial vessels. 3 patients had mid-systolic clicks, 5 had systolic murmurs, and 2 patients had both a click and a murmur. Holter electrocardiographic monitoring revealed atrial, junctional, or ventricular extrasystoles (5 patients), paroxysmal atrial fibrillation (3), and paroxysmal ventricular tachycardia (1). Left ventricular angiography confirmed mitral-leaflet prolapse in all the patients. The focal nature of the T.I.A.s suggests an embolic event, the embolus arising from the abnormal mitral valve. In a patient not included in this series, a small antemortem left atrial thrombus was found at necropsy.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000209:etiology; D002533:Cerebral Angiography; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D011391:Prolapse / Q000150:complications / Q000175:diagnosis; D013927:Thrombosis / Q000150:complications / Q000209:etiology