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The serpentine mitral valve and cerebral embolism

DOI: 10.1186/1476-7120-9-7

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Abstract:

In this case report a valvular strand, giving a peculiar serpentine appearance to the mitral valve is described. This mitral valvular strand was the only explanation for an episode of cerebral embolism, presenting with a transient right sided hemiparesis.It is proposed that a randomized study involving combined treatment with aspirin and clopidogrel is warranted in young patients with valvular strands, presenting with a first episode of cerebral embolism.Valvular strands have been described as small, well-delineated masses with a predilection for the valvular endocardium [1]. Clinically these strands present as filiform material attached to cardiac valve edges and is detected by transesophageal echocardiography [2].These strands, as visualized by transesophageal echocardiography are associated with systemic embolization, especially stroke and notably these strokes tend to occur among younger persons [3,4].A 32 year old man presented with an acute onset of right sided hemiparesis. This occurred within the matter of minutes without any preceding warning symptoms. He had no known illnesses or allergies. He was a non smoker who never had any previous surgery and did not use illicit drugs. He works in the pharmaceutical industry and never experienced any similar symptoms before.The right sided hemiparesis resolved spontaneously over the next three hours and at the time of clinical examination no objective neurological signs were present. An MRI and MRA scan of the brain and cerebral vasculature were normal. His electrocardiogram and biochemical analysis, including electrolytes, glucose, thyroid function and full blood count were within normal limits. Carotid-IMT and Doppler studies of both carotid arteries were normal. Holter electrocardiography excluded the occurrence of intermittent arrhythmias as a possible cause for embolism. Paradoxical embolism was excluded by the absence of both a patent foramen ovale and deep venous thrombosis. Infective endocarditis was excluded

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