[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.
Garnier
P
P
Service de Neurologie, Hôpital de Bellevue, Saint-Etienne.
Convers
P
P
Comtet
C
C
Cusey
I
I
Laurent
B
B
Michel
D
D
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.