INFARCT STROKE POST ATRIAL SEPTAL DEFECT CLOSURE WITH PREMATURE VENTRICULAR CONTRACTION IN YOUNG FEMALE: A CASE REPORT
1 Resident in Department of Neurology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada / Dr.Sardjito Hospital, Yogyakarta, Indonesia
2 Staff in Department of Neurology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada / Dr.Sardjito Hospital, Yogyakarta, Indonesia
A woman of 22-years old, diagnosed for ASD II HFLR left to right shunt by cardiologist two months prior, consulted to department of neurology because of acute onset of slurred speech and right sided weakness after 5 days post ASD II closure. There was no history of hypertension, diabetes, dyslipidemia, smoking or prior stroke, but ASD. The patient had ASD II 3 cm diameter closure operation. The pre-deficits electrocardiogram showed occasional PVC. On physical examination, patient was compos mentis, E4M6V5 with paresis of right XII UMN cranial nerve, right hemiparesis and positive pathologic reflex of right hand. The patient was sent to radiology department for Head CT Scan with the result acute infarct in left basal ganglia to left parietal lobe supplied by M2 branch of middle cerebral artery. The 48 hours Holter examination after acute stroke was done with the result there was no paroxysmal atrial fibrillation was identified.
In this case the patient neither had known major-risk nor minor-risk sources of cardiogenic embolism. Prior study found that in the absence of other known stroke risk factors, PVC were associated independently with increased stroke (hazard ratio 2.09 [95% CI: 1.21-3.58]) and association was strongest with embolic stroke. From total of 1415 (5.8%) participants who had at least 1 PVC at baseline, the presence of PVCs was associated with 38% increased risk of ischemic stroke. The pathophysiologic mechanism through which PVC may increase stroke risk is not well understood yet, but associated with an abnormal ventricular diastolic function. The PVC on this patient was suspected correlate to right ventricle dilatation caused by ASD II left to right shunt. Beside the PVC, the patient also had ASD operation as a risk for ischemic stroke. Cardiac surgeries are associated with higher risks for infarct stroke than noncardiac surgeries.