[Aneurysms of the intra-atrial septum complicated by cerebral ischemia in young subjects. 4 cases].
Transoesophageal echocardiography has improved the detection of potential sources of cerebral embolism. We report our experience with a group of 38 patients under 45 years of age who were examined after an arterial ischaemic cerebral event. We observed 4 patients (2 males, 2 females; age 17, 24, 38 and 40 years) with an atrial septal aneurysm. Cerebral ischaemia was permanent in 3 patients and temporary in 1 and a cerebral embolism was the most probable cause based on angiographic findings. The atrial septal aneurysm was only diagnosed by transoesophageal echocardiography (type IA in case 3, IB in the others). A patent foramen ovale was observed in 3 and this abnormality, which is known to have a high prevalence in the general population, could at most be an aggravating factor. In our series, we can assume a causal association between atrial septal aneurysm and stroke in young patients (10.5% among 38 young stroke patients vs 3% of 30 patients referred for other reasons). The treatment is still under discussion although the consensus would favour surgery if another heart malformation is associated, if a visible thrombus is identified or if repeated cerebrovascular events occur despite adequate anticoagulation. Studies conducted in large series of patients should provide more adequate therapeutic schemas.
Service de Neurologie, Hôpital de Bellevue, Saint-Etienne.
P
P
Garnier
P
P
Convers
C
C
Comtet
I
I
Cusey
B
B
Laurent
D
D
Michel
D015110:4-Hydroxycoumarins; D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006322:Heart Aneurysm / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D006346:Heart Septum / Q000000981:diagnostic imaging*; D006801:Humans; D007192:Indenes; D002546:Ischemic Attack, Transient / Q000209:etiology*; D008297:Male; D014812:Vitamin K / Q000037:antagonists & inhibitors / Q000627:therapeutic use
D015110:4-Hydroxycoumarins; D000925:Anticoagulants; D007192:Indenes; C011664:antivitamins K; D014812:Vitamin K
Anévrysmes du septum inter-auriculaire compliqués d'ischémie cérébrale chez le sujet jeune. 4 observations.