London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 365 157 Interesting and challenging cases A rare cause of stroke in a young woman – two possible underlying mechanisms? V. K. Nelatur1, U. Khan2 St George’s Healthcare NHS Trust, London, UNITED KINGDOM1, St George’s Healthcare NHS Trust, London, UNITED KINGDOM2 We report the case of a 37 year old woman, with a previous medical and family history of migraine, who developed migrainous sounding, non-postural headache six hours after spontaneous vaginal de-livery. This continued at home but she re-presented several days later with sudden severe exacerba-tion of occipital headache associated with vertigo, nausea, loss of balance, numbness in the left arm and fluctuating right eyelid ptosis. She was discharged after all her symptoms improved and MRI and MRV were reported as normal. She re-presented with worsening and at this point she had a clear right lateral medullary syndrome. A repeat MRI confirmed acute infarction in the right lateral medulla. In addition, she had evidence of convexity subarachnoid haemorrhage at the vertex(present subtly on her first MRI on subsequent review).Her MRA demonstrated diffuse attenuation of both vertebral arteries extending intracranial-ly and multiple irregularities of most of the circle of Willis. The radiological appearance of both ver-tebrals was suspicious for dissection but the remaining radiological findings supported a post-partum angiopathy, a form of reversible cerebral vasoconstriction syndrome(RCVS). The latter diagnosis was made on the basis of clinical and radiological findings after cerebral vasculitis was excluded with a normal vasculitic screen and lumbar puncture. She was treated with aspirin and the arterial vasodilator nimodipine, with rapid initial clinical improvement and subsequent slower improvement in the radiological abnormalities. The post-partum state is a recognised trigger for RCVS causing a variety of neurological insults. This case highlights the increasingly recognised association between cervical artery dissection and RCVS, mainly occurring in the vertebral arteries and in the post-partum state. The mechanisms underlying this process are not yet well understood. There is no evidence for specific treatments al-though vasodilators and antiplatelets have been used. 158 Interesting and challenging cases An Unusual case of symptomatic Patent Foramen Ovale causing stroke in an older patient M. Bhargava1, M. Tafti2 Basildon and Thurrock University Hospital NHS Foundation Trust, Basildon, UNITED KINGDOM1, Basildon and Thurrock University Hospital NHS Foundation Trust, Basildon, UNIT-ED KINGDOM2 Background: The prevalence of Patent Foramen Ovale (PFO) is about 25 percent in the general pop-ulation. This is however seen in patients who have had a stroke at age less than 55 years. It is rather uncommon to detect symptomatic PFO in the older age group. We present an unusual case of PFO causing stroke in a 65 year old patient. Case history: A 65 year old gentleman presented to the Stroke unit with left sided weakness. He had had a recent laparotomy for strangulated inguinal hernia 2 weeks prior. MRI confirmed multiple anterior circulation infarcts raising the possibility of embolization. He subsequently developed right leg pain. Dopplers showed extensive DVT extending up to the mid-thigh. This raised the possibility of paradoxical embolization. A subsequent contrast ECHO and trans oesophageal ECHO confirmed PFO with dysplastic and aneurysmal ASD. He was treated with 6 months of anti-coagulation for DVT and is awaiting surgery for ASD closure. Discussion: PFO causing symptoms in older age group is rather unusual. It is important to maintain a high index of suspicion and investigate appropriately if clinically indicated.
Karger_ESC London_2013
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