Paradoxical Embolism to the Basilar Apex Associated With May-Thurner Syndrome

Abstract

Deep venous thrombosis is notorious for its variable clinical manifestations and the potential dire consequences of a missed diagnosis. Physicians caring for patients with presumed paradoxical embolism should assess for May-Thurner syndrome.

May-Thurner Syndrome in Patients With Cryptogenic Stroke and Patent Foramen Ovale

“…Although the association between MTS and cryptogenic stroke was previously reported in case reports (3, 4), the current study is the first large-scale analysis of the association between MTS, cryptogenic stroke and PFO. In our study we found an incidence of MTS of 6.3% in patients diagnosed with cryptogenic stroke having undergone PFO closure.…”

“…Apart from case reports (3, 4), the association of MTS with cryptogenic stroke in the context of a patent foramen ovale (PFO) has not been studied. The incidence of MTS in patients with cryptogenic stroke and PFO is unknown.…”

Acute paradoxical embolic cerebral ischemia secondary to possible May-Thurner syndrome and an atrial septal defect: a case report

“…Cerebral emboli have been reported to account for approximately 15% of all ischemic strokes [1]. ASDs and PFOs are congenital cardiac defects that have been associated with paradoxical cryptogenic ischemic stroke.…”

“…MTS consists of venous flow impedance of the left common iliac vein by the overlying right common iliac artery, which may lead to intimal hypertrophy, further flow impedance, and thrombus formation secondary to chronic pulsatile forces. MTS has been estimated to occur in 20% of the population and the average age of onset is between 18 and 30 years of age and is approximately five times more common in women than men [1,3-6]. …”

“…In MTS, a deep vein thrombosis of the iliofemoral vein may form due to compression of the left common iliac vein by the overlying right common iliac artery, which can result in a paradoxical embolism if the patient also possesses a patent foramen ovale (PFO) or atrial septal defect (ASD) [1]. We report a case of an embolic cerebral ischemic event possibly resulting from MTS coupled with an ASD.…”