Yonemitsu M, Hashimoto Y, Ohbayashi K, Kimura K, Uchino M
Department of Neurology, Kumamoto City Hospital.
Rinsho Shinkeigaku. 1998 Jan;38(1):66-9.
We reported two young adults (a 42-year-old female and a 45-year-old male) with tension type headache who had a patent foramen ovale and atrial septal aneurysm demonstrated by transesophageal echocardiography, associated with asymptomatic cerebral infarctions. There were multiple subcortical infarctions in the frontal and parietal lobes in case 1, and cerebral infarctions in the right corona radiata, head and body of the caudate nucleus, and putamen in case 2. The two cases did not have hypertension, diabetes mellitus, hyperlipidemia, cardiac diseases detected by electrocardiography and transthoracic echocardiography, and abnormality of intracranial and extracranial arteries by ultrasound sonography and cerebral angiography. Transeosophageal echocardiography revealed atrial septal aneurysm, and showed right-to-left shunt (patent foramen ovale) by Valsalva maneuver. Two cases were diagnosed as paradoxical cerebral embolism associated with a patent foramen ovale. If asymptomatic cerebral infarctions are cryptogenic stroke, a patent foramen ovale and atrial septal aneurysm should be examined by transesophageal echocardiography with Valsalva maneuver.
我们报告了两名紧张型头痛的年轻成年人（一名42岁女性和一名45岁男性），经食管超声心动图显示他们存在卵圆孔未闭和房间隔瘤，并伴有无症状性脑梗死。病例1在额叶和顶叶有多个皮质下梗死灶，病例2在右侧放射冠、尾状核头和体部以及壳核有脑梗死灶。这两个病例均无高血压、糖尿病、高脂血症，心电图和经胸超声心动图未检测到心脏疾病，超声检查和脑血管造影未发现颅内和颅外动脉异常。经食管超声心动图显示房间隔瘤，并通过Valsalva动作显示右向左分流（卵圆孔未闭）。这两个病例被诊断为与卵圆孔未闭相关的反常性脑栓塞。如果无症状性脑梗死是隐源性卒中，应通过经食管超声心动图结合Valsalva动作检查卵圆孔未闭和房间隔瘤。
