Key result
A rare case of spontaneous cerebral infarction was caused by embolism from a thrombus in the sinus of Valsalva, which completely disappeared after 3 months of anticoagulant therapy.
Case Report (n=1)
No
This is the first reported case of isolated cerebral infarction caused by secondary embolism from a thrombus in the sinus of Valsalva, which successfully resolved with anticoagulant therapy.
Highlights sinus of Valsalva thrombus as rare embolic source; hypothesis-generating and should not change practice.
要旨：66 歳男性．突然の失語症状，右不全片麻痺を来して当院を救急受診した．頭部MRI 拡散強調画像で左中大脳動脈領域に散在性高信号域を認め，脳梗塞と診断しrt-PA 投与を行った．入院後の心臓エコー検査で，Valsalva 洞部に異常エコー所見を認め，さらに胸部造影CT 検査で大動脈直上部に造影欠損部を認めた．血管内血栓の場合，動脈塞栓症を引き起こす危険性があることからカテーテル検査は施行しなかった．この病変が塞栓形成原因と考え抗凝固療法を開始した．抗凝固療法開始3 カ月後のフォローアップ心臓エコー検査で異常エコー所見は消失していたことからValsalva 洞内血栓であったと考えられた．Valsalva 洞内の血栓形成によって生じた急性冠動脈症候群に脳梗塞を併発した報告はなされているが，脳梗塞を単独発症した症例は渉猟した限りでは今回が初めての報告である．ここに文献的考察を加えて報告する．
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Yokosawa et al. (2015) conducted a case report in Cerebral infarction (n=1). Anticoagulant therapy was evaluated on Resolution of thrombus. A rare case of spontaneous cerebral infarction was caused by embolism from a thrombus in the sinus of Valsalva, which completely disappeared after 3 months of anticoagulant therapy.
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