May-Thurner 증후군에 의한 기이 색전 뇌경색 1예

Abstract

Paradoxical embolism is thought to be a common cause for cryptogenic stroke. The right-to-left shunt such as patent foramen ovale (PFO) is usually considered an essential condition of thromboembolism. However, May- Thurner syndrome (MTS) could be a possible source of thromboembolism, which is an anatomical position variant between right common iliac artery and left common iliac vein. We report a case of paradoxical embolism associated with MTS and PFO. A 39-year-old woman visited our hospital due to sensory dominant aphasia. Her symptoms suddenly developed in squatting position. Brain MRI showed left middle cerebral artery infarction with normal MR angiography. Transesophageal echocardiography revealed positive PFO test without any thrombus. Two weeks before admission, she had developed edema on her left lower extremity. We evaluated lower extremities by CT angiography, which revealed deep venous thrombosis from the left iliac to saphenous vein with underlying MTS. PFO is a relatively common anatomical variant that could serve as a gate for a paradoxical embolism, and MTS is not a rare syndrome in normal individuals. Neurologists should keep in mind that MTS may be the potential source of paradoxical embolism in patient with PFO. (Korean Journal of Stroke 2005;7(2): 224~227)