Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of cerebral embolism treated with early surgical intervention for aneurysm of sinus of Valsalva as embolic source

Kanako Menjo, M.D.1), Keisuke Imai, M.D.1), Masashi Hamanaka, M.D.1), Atsushi Yamamoto, M.D.1), Akiyuki Takahashi, M.D., Ph.D.2) and Jun Shiraishi, M.D., Ph.D.3)

1) Department of Neurology and Stroke Treatment, Kyoto First Red Cross Hospital
2) Department of Cardiovascular Surgery, Kyoto First Red Cross Hospital
3) Department of Cardiology, Kyoto First Red Cross Hospital

The patient was a 78-year-old man. He was transferred to the emergency room presenting with aphasia and right hemiplegia. Head CT and CT angiography demonstrated a narrow territory of early ischemic signs and occlusion of the horizontal segment of the left middle cerebral artery (MCA), respectively. Endovascular thrombectomy was performed and complete recanalization of MCA was achieved. After admission, transthoracic echocardiography revealed a cystic mass near the left coronary apex of the aortic valve, which was diagnosed as an aneurysm of the sinus of Valsalva (ASV) by contrast-enhanced chest computed tomography. Transesophageal echocardiography showed a severe smoke-like echo within ASV, despite being in sinus rhythm. Intravenous anticoagulant therapy was started, and patch closure was performed by cardiovascular surgeons on the 13th day despite of early period after stroke onset. During the operation, no thrombus was seen around the inlet of ASV. On the two days after the operation, paroxysmal atrial fibrillation was detected and anticoagulant therapy was continued. In this patient, ASV was regarded as the embolic source of cerebral embolism, and anticoagulant therapy and surgical intervention were selected in the early period after stroke onset to prevent embolism recurrence, resulting in a favorable clinical course.
Full Text of this Article in Japanese PDF (4082K)

(CLINICA NEUROL, 62: 458−463, 2022)
key words: cerebral embolism, aneurysm of sinus of Valsalva, smoke-like echo, anticoagulant therapy, patch closure

(Received: 5-Aug-21)