title: Cryptogenic transient ischemic attack after nose blowing: association of huge atrial septal aneurysm with patent foramen ovale as potential cause.
abstract: Association of atrial septal aneurysm (ASA) with patent foramen ovale (PFO) is considered an important risk factor for cardioembolism frequently forwarding paradoxical embolism in patients with cryptogenic or unexplained cerebral ischemic events. We herein describe the case of a 69-year-old male patient reporting uncontrolled movements of the right arm due to a muscle weakness, slurred speech, and paresthesia in the oral region some seconds after he had blown his nose. These neurological symptoms had improved dramatically within a few minutes and were completely regressive at admission to our hospital about two hours later. On transesophageal echocardiography (TEE) a huge ASA associated with PFO was detected. Diagnosis of the large-sized ASA was also confirmed by cardiac magnetic resonance imaging. Due to the early complete recovery from his neurological symptoms, the patient was diagnosed with a transient ischemic attack (TIA). After nine days he was discharged in a good clinical condition under the treatment with oral anticoagulation. It is concluded that in cryptogenic or unexplained stroke or TIA TEE should always be performed to rule out ASA and PFO as potential sources for paradoxical embolism in those inconclusive clinical situations.
authors.affiliation: Department of Internal Medicine, DRK Krankenhaus Sondershausen, Sondershausen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Lotze
authors.forename: Uwe
authors.initials: U
authors.lastname: Kirsch
authors.forename: Marc-Alexander
authors.initials: MA
authors.lastname: Ohlow
authors.forename: Thorsten
authors.initials: T
authors.lastname: Scholle
authors.forename: Jochen
authors.initials: J
authors.lastname: Leonhardi
authors.forename: Bernward
authors.initials: B
authors.lastname: Lauer
authors.forename: Gerhard
authors.initials: G
authors.lastname: Oltmanns
authors.forename: Hendrik
authors.initials: H
authors.lastname: Schmidt
keywords: atrial septal aneurysm; congenital cardiac abnormality; nose blowing; paradoxical embolism; patent foramen ovale; transient ischemic attack