Arakawa Masafumi, Shimoyama Takashi, Matsumoto Noriko, Suda Satoshi, Kurita Jiro, Kimura Kazumi
Department of Neurological Science, Graduate School of Medicine, Nippon Medical School.
Department of Cardiovascular surgery, Graduate School of Medicine, Nippon Medical School.
Rinsho Shinkeigaku. 2017 Oct 27;57(10):584-590. doi: 10.5692/clinicalneurol.cn-001069. Epub 2017 Sep 28.
A 67-year-old woman developed weakness of the entire left side of the body and disturbance of consciousness, and was admitted to our hospital. She had atrial fibrillation (AF) on arrival at the hospital. Diffusion weighted magnetic resonance imaging showed high intensity area in the right basal ganglia, and magnetic resonance angiography showed occlusion of the right internal carotid artery (ICA). Thrombolytic therapy with intravenous tissue plasminogen activator (IV tPA) was administered 225 minutes after onset, and endovascular procedure also performed. After endovascular therapy, the patient had successful recanalization of the right ICA. Transesophageal echocardiography (TEE) showed a mass in the left atrium. Cardiac surgery for the excision of a left atrial mass and the maze procedure for atrial fibrillation were performed on the 29th hospital day. The mass was pathologically confirmed as thrombus. Follow up TEE after cardiac surgery revealed recurrence of thrombus at the both origin of pulmonary vein in the left atrium. Finally, the thrombus was disappeared at 6-month after onset with taking warfarin. She had no stroke events during the clinical course.
一名67岁女性出现左侧身体整体无力及意识障碍，遂入住我院。入院时她患有心房颤动（AF）。弥散加权磁共振成像显示右侧基底节区有高强度区域，磁共振血管造影显示右侧颈内动脉（ICA）闭塞。在发病225分钟后给予静脉注射组织型纤溶酶原激活剂（IV tPA）进行溶栓治疗，并同时进行了血管内介入操作。血管内治疗后，患者右侧ICA成功再通。经食管超声心动图（TEE）显示左心房有一肿块。在住院第29天进行了心脏手术切除左心房肿块及房颤迷宫手术。该肿块经病理证实为血栓。心脏手术后的随访TEE显示左心房肺静脉起始处均有血栓复发。最后，在发病6个月时服用华法林后血栓消失。在整个临床过程中她未发生中风事件。
