Yeungnam Univ J Med.  2015 Dec;32(2):118-121. 10.12701/yujm.2015.32.2.118.

Unusual paradoxical embolic stroke in a patient with persistent left superior vena cava

• Kwon TH
• Choi KU
• Kim BJ
• Cho JH
• Lee JY
• Park KH
• Lee SH
• Son JW

• KMID: 2319912
• DOI: http://doi.org/10.12701/yujm.2015.32.2.118

Abstract

Cardiogenic embolic stroke accounts for approximately 20% of ischemic strokes and the likelihood of its recurrence is high. Paradoxical embolism may be an important cause of cardioembolic stroke, which can be evaluated through multiple diagnostic modalities including transesophageal echocardiography (TTE) or transcranial Doppler. A persistent left superior vena cava (PLSVC) is a rare congenital vascular anomaly, which mainly drains to the right atrium via the coronary sinus. Although rare, PLSVC draining into the left heart predisposes the patient to paradoxical embolism through a right-to-left shunt. We report on a 78-year-old female patient with an ischemic stroke associated with PLSVC draining into the left atrium through the pulmonary vein, which was investigated via TTE with an agitated saline test and computed tomography.

Keyword

Persistent left superior vena cava; Stroke; Paradoxical embolism

MeSH Terms

Aged
Coronary Sinus
Dihydroergotamine
Echocardiography, Transesophageal
Embolism, Paradoxical
Female
Heart
Heart Atria
Humans
Pulmonary Veins
Recurrence
Stroke*
Vena Cava, Superior*
Dihydroergotamine