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What can a cryptogenic stroke hide in a young patient? Cover

What can a cryptogenic stroke hide in a young patient?

Romanian Journal of Cardiology
Volume 33 (2023): Issue 4 (December 2023)
By: Maria-Ruxandra Cepoi,  Ioana Theodora Vrabie,  Cosmina Ponor,  Ana Nicolae,  Marilena Renata Spiridon,  Antoniu Octavian Petriș and  Irina Iuliana Costache  
Open Access
|Dec 2023

Figures & Tables

Figure 1.

A – Nativ CT cerebral examination: spontaneous hyperdense -aspect of the M3 segment of the right MCA, indicative of acute thrombosis at admission; B - Nativ CT cerebral examination: hypodense area in the right temporo-insular and cortico-subcortical region, which was erasing intergyral grooves and causing loss of differentiation between white and gray matter, consistent with an acute ischemic area in the territory of the right MCA after 24 hours; C – Cranio-cerebral MRI: the diffusion sequence shows hypersignal in the same region, corresponding to hyposignal in the ADC map, characteristic of a recently developed stroke in the territory of the right MCA after 5 days.
A – Nativ CT cerebral examination: spontaneous hyperdense -aspect of the M3 segment of the right MCA, indicative of acute thrombosis at admission; B - Nativ CT cerebral examination: hypodense area in the right temporo-insular and cortico-subcortical region, which was erasing intergyral grooves and causing loss of differentiation between white and gray matter, consistent with an acute ischemic area in the territory of the right MCA after 24 hours; C – Cranio-cerebral MRI: the diffusion sequence shows hypersignal in the same region, corresponding to hyposignal in the ADC map, characteristic of a recently developed stroke in the territory of the right MCA after 5 days.

Figure 2

ECG trace: sinus tachycardia 110/min, left atrial dilatation (evidenced by negative, widened, and deepened P wave in V1), first-degree atrioventricular block, left ventricular hypertrophy (Sokolow-Lyon index-37 mm and left ventricular “strain” pattern).
ECG trace: sinus tachycardia 110/min, left atrial dilatation (evidenced by negative, widened, and deepened P wave in V1), first-degree atrioventricular block, left ventricular hypertrophy (Sokolow-Lyon index-37 mm and left ventricular “strain” pattern).

Figure 3

TTE – A – PLAX – IVS 8 mm and LVPW 10 mm, dilatation of the left atrium and the aortic and mitral valves with normal morphology; B - A4C – dilatation of the left heart cavities and LV hypertrabeculations at the level of the apex and lateral wall; C – A2C –LV hypertrabeculations at the level of the inferior wall and LV apex.
TTE – A – PLAX – IVS 8 mm and LVPW 10 mm, dilatation of the left atrium and the aortic and mitral valves with normal morphology; B - A4C – dilatation of the left heart cavities and LV hypertrabeculations at the level of the apex and lateral wall; C – A2C –LV hypertrabeculations at the level of the inferior wall and LV apex.

Figure 4

TTE - A4C - the ratio of trabeculated area/normal myocardium = 1.85; B – Medioventricular SAX – the presence of hypertrabeculation at the level of anterior, lateral, posterior and inferior LV walls; C – Apical SAX – circumferential hypertrabeculation of LV.
TTE - A4C - the ratio of trabeculated area/normal myocardium = 1.85; B – Medioventricular SAX – the presence of hypertrabeculation at the level of anterior, lateral, posterior and inferior LV walls; C – Apical SAX – circumferential hypertrabeculation of LV.

Figure 5

TTE – A - Colour Doppler A4C – moderate mitral regurgitation secondary to mitral annulus dilatation with the regurgitation jet centrally oriented; B – Mitral PW Doppler A4C-restrictive flow pattern – diastolic dysfunction grade 3 (E=135 cm/sec, A=60 cm/sec, E/A=2,26); C – Septal TDI A4C – restrictive filling pattern (e’=2 cm/s, a’=10 cm/s, s’=1 cm/s, E/e’=67,5).
TTE – A - Colour Doppler A4C – moderate mitral regurgitation secondary to mitral annulus dilatation with the regurgitation jet centrally oriented; B – Mitral PW Doppler A4C-restrictive flow pattern – diastolic dysfunction grade 3 (E=135 cm/sec, A=60 cm/sec, E/A=2,26); C – Septal TDI A4C – restrictive filling pattern (e’=2 cm/s, a’=10 cm/s, s’=1 cm/s, E/e’=67,5).

Figure 6

CMR – A – short axis image of the LV from base to apex at end-diastole, regions of prominent trabeculation at the level of anterior, antero-lateral walls, and infero-laterally in the basal and medio-ventricular segments; B – left ventricular outflow tract section, areas of accentuated trabeculation at the level of apex and lateral wall.
CMR – A – short axis image of the LV from base to apex at end-diastole, regions of prominent trabeculation at the level of anterior, antero-lateral walls, and infero-laterally in the basal and medio-ventricular segments; B – left ventricular outflow tract section, areas of accentuated trabeculation at the level of apex and lateral wall.

Figure 7

Follow-up TTE at 3 months – A – Colour Doppler A4C - Dilatation of the left heart cavities is maintained, but mitral regurgitation shows improvement; B – Mitral PW Doppler A4C and C – Septal TDI A4C – diastolic dysfunction grade 1 – impaired relaxation (E=54 cm/sec, A=70 cm/sec, E/A=0.78, septal e’=7cm/sec, septal a’=8 cm/sec, septal s’=5 cm/sec, E/e’=7,7); D – A2C and E – PSAX – trabeculated appearance of LV.
Follow-up TTE at 3 months – A – Colour Doppler A4C - Dilatation of the left heart cavities is maintained, but mitral regurgitation shows improvement; B – Mitral PW Doppler A4C and C – Septal TDI A4C – diastolic dysfunction grade 1 – impaired relaxation (E=54 cm/sec, A=70 cm/sec, E/A=0.78, septal e’=7cm/sec, septal a’=8 cm/sec, septal s’=5 cm/sec, E/e’=7,7); D – A2C and E – PSAX – trabeculated appearance of LV.

Figure 8

Follow-up ECG at 3 months: sinus rhythm 78/min, first-degree atrioventricular block (PR 240 msec), left ventricular hypertrophy (Sokolow-Lyon index > 35 mm, and left ventricular “strain” pattern).
Follow-up ECG at 3 months: sinus rhythm 78/min, first-degree atrioventricular block (PR 240 msec), left ventricular hypertrophy (Sokolow-Lyon index > 35 mm, and left ventricular “strain” pattern).
DOI: https://doi.org/10.2478/rjc-2023-0032 | Journal eISSN: 2734-6382 | Journal ISSN: 1220-658X
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Language: English
Page range: 161 - 168
Published on: Dec 26, 2023
Published by: Romanian Society of Cardiology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
left ventricular hypertrabeculation,
cardiomyopathy,
heart failure,
ischemic stroke
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Cardiology,
Pediatrics and juvenile medicine,
Paediatric cardiology,
Surgery,
Cardiac surgery

© 2023 Maria-Ruxandra Cepoi, Ioana Theodora Vrabie, Cosmina Ponor, Ana Nicolae, Marilena Renata Spiridon, Antoniu Octavian Petriș, Irina Iuliana Costache, published by Romanian Society of Cardiology
This work is licensed under the Creative Commons Attribution 4.0 License.

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