Ischemic stroke on the background of probable in situ thrombosis of atrial septal aneurysm in a patient taking hormonal contraceptives

Abstract

Introduction. The independent role of the atrial septal aneurysm in the occurrence of ischemic stroke remains controversial. In addition to the mechanism of paradoxical embolism against the background of a patent foramen ovale associated with an aneurysm, a number of studies have demonstrated that ischemic stroke can develop due to in situ thrombosis in the aneurysm region.Materials and methods. Description of the clinical case of a patient with atrial septal aneurysm and ischemic stroke while taking hormonal contraceptives. Analyzed all available publications in PubMed on this topic.Results and discussion. Among publications suitable for the criteria, in addition to direct visualization of a blood clot in the area of the atrial septal aneurysm, its independent effect on the occurrence of embolic events was demonstrated. In all analyzed cases, anticoagulants were prescribed for secondary prevention, which is justified on the basis of the hypothesis of in situ thrombosis in the aneurysm region.Conclusion. The analysis of scientific publications showed that the knowledge of this problem is still extremely small. There are no clear criteria, in addition to direct visualization of a blood clot, allowing the atrial septal aneurysm to be considered as a direct cause of ischemic stroke. Nevertheless, the presence of this cardiac abnormality and in combination with risk factors or evidence of prothrombotic status make it possible to regard it as an independent cause of stroke, and qualify the stroke as cardioembolic, which justifies the advisability of prescribing anticoagulants for secondary prevention.

Keywords

• ischemic stroke
• cardioembolic stroke
• atrial septal aneurysm
• paradoxical embolism
• echocardiography