Ikeuchi Yusuke, Ashida Noriaki, Nishihara Masamitsu, Hosoda Kohkichi
Division of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Hyogo, Japan.
J Neuroendovasc Ther. 2022;16(8):402-408. doi: 10.5797/jnet.cr.2021-0087. Epub 2021 Dec 18.
Unlike in older adults, ischemic stroke in young patients occurs secondary to preexisting conditions. Infective endocarditis (IE) is among the most important causes of stroke in young adults and has a severe prognosis. There are few reports of mechanical thrombectomy (MT) for IE-induced large-vessel occlusion (LVO). This paper reports a case of acute IE-induced LVO in a young patient who was successfully treated with MT.
An 18-year-old woman presented to our hospital with severe headache, high fever, and left fingertip pain. She was admitted to the Department of Neurology for conservative treatment of suspected meningitis. On day 2 of admission, she developed acute left hemiparesis, left hemispatial neglect, and dysarthria. MRA showed occlusion of the right M1 segment of the middle cerebral artery, and the patient immediately underwent MT. After a single pass, we achieved thrombolysis in cerebral infarction 2b. A white clot was diagnosed as a vegetation on pathological examination. As transesophageal echocardiography showed a vegetation on the mitral valve, the patient was diagnosed with IE and underwent cardiovascular surgery. The patient recovered well and underwent additional treatment and rehabilitation.
Although rare, IE-induced septic emboli may occur in young patients with LVO, necessitating MT and pathological diagnosis of the clot.
与老年人不同，年轻患者的缺血性卒中继发于既往存在的疾病。感染性心内膜炎（IE）是年轻成年人卒中的最重要原因之一，且预后严重。关于IE所致大血管闭塞（LVO）的机械取栓术（MT）的报道很少。本文报告了1例年轻患者因急性IE导致LVO并成功接受MT治疗的病例。
一名18岁女性因严重头痛、高热和左手指尖疼痛就诊于我院。她因疑似脑膜炎被收入神经内科进行保守治疗。入院第2天，她出现急性左侧偏瘫、左侧空间忽视和构音障碍。磁共振血管造影（MRA）显示大脑中动脉右侧M1段闭塞，患者随即接受MT治疗。单次取栓后，实现了2b级脑梗死溶栓。病理检查将白色血栓诊断为赘生物。经食管超声心动图显示二尖瓣有赘生物，该患者被诊断为IE并接受了心血管手术。患者恢复良好，并接受了进一步治疗和康复。
尽管罕见，但IE引起的脓毒性栓子可能发生在患有LVO的年轻患者中，需要进行MT及对血栓进行病理诊断。
