Migraine with aura and paradoxical embolism: case report
Abstract
Case presentation: A 29-year-old female patient, a smoker (1 pack/day) with a history of migraine with visual aura since the age of 15, was admitted to an emergency service with a sudden onset of dysarthria and facial asymmetry associated with intense headache, followed within a few hours by complete right-sided hemiparesis. She was admitted with 11 points on the NIHSS (National Institute of Health Stroke Scale) and underwent a cranial Computed Tomography (CT) scan, which revealed hypodense lesions in the right frontal, insular, and nucleocapsular regions, suggesting an acute ischemic event. Cranial CT angiography identified areas of narrowing and luminal irregularities in the M2 branch of the left middle cerebral artery. Further etiological investigation for ischemic stroke (IS) in a young patient included: Carotid and Vertebral Doppler (CVD) without evidence of stenosis; Transthoracic Echocardiogram showing regular rhythm, normal left atrial volume, 61% ejection fraction, and the presence of an aneurysmal interatrial septum; and Transcranial Doppler with microbubble test revealing the presence of a right-to-left shunt. The patient is awaiting scheduling for a transesophageal echocardiogram and 24-hour Holter monitoring. She remains on prophylaxis with Aspirin 100 mg and Simvastatin 40 mg. Discussion: Stroke is one of the leading causes of death and acquired disability worldwide. Brazil has the fourth highest mortality rate from this condition among Latin American…
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