Fatal cerebral and cardiac infarction due to embolism of a mobile thrombus from aorta sinotubular junction atheroma in a 40-year-old female
DOI:
https://doi.org/10.14739/2310-1210.2020.4.208414Keywords:
sinotubular junction atheroma, mobile thrombus, cerebral infarction, myocardial infarction, young ageAbstract
Strokes in young adults present a challenging problem in terms of care and social impact. Most of cases in this cohort are classified as strokes of uncertain etiology. Application of multimodality diagnostic approach could help in the estimation of risk factors and underlying mechanisms. Simultaneous acute cardio-cerebral infarction is a rare manifestation, especially in young individuals. Large artery atherosclerosis should be excluded as a potential cause. Transesophageal echocardiography plays an important role in the diagnostic algorithm.
The current article presents a clinical case of a fatal acute cardio-cerebral infarction in a 40-year old female without previous cardiovascular diseases and negative family history. Transesophageal echocardiography identified a large mobile thrombus at the sinotubular junction of ascending aorta. Transthoracic echocardiography revealed regional akinesia of the inferior wall, despite normal electrocardiogram. The autopsy findings confirmed co-occurrence of thromboembolic stroke in the right middle cerebral artery area and left ventricular inferior myocardial infarction due to thrombosis of the right coronary artery. This case documents an exceedingly rare phenomenon in this cohort of a cardio-cerebral thromboembolism due to single atherosclerotic plaque destabilization.
References
Smajlović, D. (2015). Strokes in young adults: epidemiology and prevention. Vascular Health and Risk Management, 11, 157-164. https://doi.org/10.2147/VHRM.S53203
Varona, J. F., Guerra, J. M., Bermejo, F., Molina, J. A., & Gomez de la Cámara, A. (2007). Causes of Ischemic Stroke in Young Adults, and Evolution of the Etiological Diagnosis over the Long Term. European Neurology, 57(4), 212-218. https://doi.org/10.1159/000099161
Stack, C. A., & Cole, J. W. (2018). Ischemic stroke in young adults. Current Opinion in Cardiology, 33(6), 594-604. https://doi.org/10.1097/hco.0000000000000564
van Alebeek, M. E., Arntz, R. M., Ekker, M. S., Synhaeve, N. E., Maaijwee, N. A., Schoonderwaldt, H., van der Vlugt, M. J., van Dijk, E. J., Rutten-Jacobs, L. C., & de Leeuw, F.-E. (2017). Risk factors and mechanisms of stroke in young adults: The FUTURE study. Journal of Cerebral Blood Flow & Metabolism, 38(9), 1631-1641. https://doi.org/10.1177/0271678x17707138
Agmon, Y., Khandheria, B. K., Meissner, I., Schwartz, G. L., Petterson, T. M., O’Fallon, W. M., Whisnant, J. P., Wiebers, D. O., & Seward, J. B. (2002). Relation of coronary artery disease and cerebrovascular disease with atherosclerosis of the thoracic aorta in the general population. The American Journal of Cardiology, 89(3), 262-267. https://doi.org/10.1016/s0002-9149(01)02225-1
Pujadas Capmany, R., Oliveras Ibanez, M., & Jane Pesquer, X. (2010). Complex Atheromatosis of the Aortic Arch in Cerebral Infarction. Current Cardiology Reviews, 6(3), 184-193. https://doi.org/10.2174/157340310791658712
Numata, S., Itatani, K., Kanda, K., Doi, K., Yamazaki, S., Morimoto, K., Manabe, K., Ikemoto, K., & Yaku, H. (2016). Blood flow analysis of the aortic arch using computational fluid dynamics. European Journal of Cardio-Thoracic Surgery, 49(6), 1578-1585. https://doi.org/10.1093/ejcts/ezv459
Fugate, J. E., & Rabinstein, A. A. (2015). Absolute and Relative Contraindications to IV rt-PA for Acute Ischemic Stroke. The Neurohospitalist, 5(3), 110-121. https://doi.org/10.1177/1941874415578532
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