Fatal cerebral and cardiac infarction due to embolism of a mobile thrombus from aorta sinotubular junction atheroma in a 40-year-old female

Authors

DOI:

https://doi.org/10.14739/2310-1210.2020.4.208414

Keywords:

sinotubular junction atheroma, mobile thrombus, cerebral infarction, myocardial infarction, young age

Abstract

 

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

Downloads

How to Cite

1.
Kavalerchyk V, Kolesnyk M, Woehlke M, Staudt A, Hagendorff A. Fatal cerebral and cardiac infarction due to embolism of a mobile thrombus from aorta sinotubular junction atheroma in a 40-year-old female. Zaporozhye Medical Journal [Internet]. 2020Jul.22 [cited 2024Nov.2];22(4). Available from: http://zmj.zsmu.edu.ua/article/view/208414

Issue

Vol. 22 No. 4 (2020)

Section

Case Reports

License

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons
    2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
    3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)