Двусторонний таламический инсульт у пациентки с открытым овальным окном и наследственной тромбофилией

Читать PDF

Аннотация

Наличие открытого овального окна и наследственной тромбофилии является достоверными факторами риска развития ишемического инсульта. Артерия Першерона представляет собой редкий анатомический вариант, при котором обширные отделы среднего мозга и таламуса имеют единственный источник кровоснабжения. В данном клиническом наблюдении представлена пациентка с двусторонним таламическим инсультом в бассейне артерии Першерона, который развился на фоне сочетания наследственной тромбофилии и дефекта овального окна, а также обсуждены современные подходы к диагностике и вторичной профилактике данной патологии.

Ключевые слова: открытое овальное окно, ишемический инсульт, тромбофилия.

________________________________________________

Patent foramen ovale and hereditary thrombophilia are both known risk factors for ischemic stroke. Artery of Percheron is a rare anatomical variant in which vast areas of the midbrain and thalamus have a single source of blood supply. This case report presents a 45-years old female patient with bilateral thalamic stroke due to Percheron artery occlusion, with a combination of hereditary thrombophilia and patent foramen ovale as the risk factors. Modern approaches to the diagnosis and secondary prevention of this pathology are also discussed herein.

Keywords: patent foramen ovale, ischemic stroke, thrombophilia.

Список литературы

1. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160-236. doi: 10.1161/STR.0000000000000024
2. Caruso P, Manganotti P, Moretti R. Complex neurological symptoms in bilateral thalamic stroke due to Percheron artery occlusion. Vasc Health Risk Manag. 2017;13:11-4. doi: 10.2147/VHRM.S119395
3. Riaz I Bin, Dhoble A, Mizyed A, et al. Transcatheter patent foramen ovale closure versus medical therapy for cryptogenic stroke: a meta-analysis of randomized clinical trials. BMC Cardiovasc Disord. 2013;13:116. https://doi.org/10.1186/1471-2261-13-116
4. Хасанов И.А. Особенности инфарктов в бассейне задних мозговых артерий. Неврологический вестник. 2012;44:69-74 [Khasanov IA, Bogdanov EI. Ishemic stroke in a system of posterior cerebral arteries: problems of diagnosis and treatment. Nevrologicheskii vestnik. 2012;44:69-74 (In Russ.)].
5. Schmahmann JD. Vascular syndromes of the thalamus. Stroke. 2003; 34:2264-78. https://doi.org/10.1161/01.STR.0000087786.38997.9E
6. Lazzaro NA, Wright B, Castillo M, et al. Artery of percheron infarction: Imaging patterns and clinical spectrum. Am J Neuroradiol. 2010;31:1283-9. https://doi.org/10.3174/ajnr.A2044
7. Arauz A, Paino-Rodriguez HM, Vargas-Gonzalez JC, et al. Clinical spectrum of artery of Percheron infarct: clinical-radiological correlations. J Stroke Cerebrovasc Dis. 2014;23(5):1083–1088.
8. Jusufovic M, Thomassen L, Skjelland M. Ischaemic stroke with patent foramen ovale. TidsskrNorLaegeforen. 2014;134:180-4. doi: 10.3174/ajnr.A2044
9. Goel SS, Tuzcu EM, Shishehbor MH, et al. Morphology of the Patent Foramen Ovale in Asymptomatic Versus Symptomatic (Stroke or Transient Ischemic Attack) Patients. Am J Cardiol. 2009;103:124-9. https://doi.org/10.1016/j.amjcard.2008.08.036
10. Poulton R, Caspi A, Milne BJ, et al. Patent foramen ovale and stroke. Lancet. 2013;360:1640-5. https://doi.org/10.1016/j.jjcc.2010.05.008
11. Alsheikh-Ali AA, Thaler DE, Kent DM. Patent foramen ovale in cryptogenic stroke: Incidental or pathogenic? Stroke. 2009;40:2349-55. https://doi.org/10.1161/STROKEAHA.109.547828
12. Zhang X-L, Kang L-N, Wang L, Xu B. Percutaneous closure versus medical therapy for stroke with patent foramen Ovale: a systematic review and meta-analysis. BMC CardiovascDisord. 2018;18:45. https://doi.org/10.1186/s12872-018-0780-x
13. Boulyjenkov V. Inherited thrombophilia: Memorandum from a joint WHO/International Society on Thrombosis and Haemostasis meeting. Bull World Health Organ. 1997;75:177-89.
14. Ng KWP, Loh PK, Sharma VK. Role of Investigating Thrombophilic Disorders in Young Stroke. Stroke Res Treat. 2011;2011:1-9. https://doi.org/10.4061/2011/670138
15. Morris JG, Singh S, Fisher M. Testing for inherited thrombophilias in arterial stroke: Can it cause more harm than good? Stroke. 2010;41:2985-90. https://doi.org/10.1161/STROKEAHA.110.595199
16. Abhinand PA, Manikandan M, Mahalakshmi R, Ragunath PK. Meta-analysis study to evaluate the association of MTHFR C677T polymorphism with risk of ischemic stroke. Bioinformation. 2017;13:214-9. https://doi.org/10.6026/97320630013214
17. Hu X, Zan X, Xie Z, et al. Association Between Plasminogen Activator Inhibitor-1 Genetic Polymorphisms and Stroke Susceptibility. MolNeurobiol. 2017; 54:328-41. https://doi.org/10.1007/s12035-015-9549-8

________________________________________________

1. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160-236. doi: 10.1161/STR.0000000000000024
2. Caruso P, Manganotti P, Moretti R. Complex neurological symptoms in bilateral thalamic stroke due to Percheron artery occlusion. Vasc Health Risk Manag. 2017;13:11-4. doi: 10.2147/VHRM.S119395
3. Riaz I Bin, Dhoble A, Mizyed A, et al. Transcatheter patent foramen ovale closure versus medical therapy for cryptogenic stroke: a meta-analysis of randomized clinical trials. BMC Cardiovasc Disord. 2013;13:116. https://doi.org/10.1186/1471-2261-13-116
4. [Khasanov IA, Bogdanov EI. Ishemic stroke in a system of posterior cerebral arteries: problems of diagnosis and treatment. Nevrologicheskii vestnik. 2012;44:69-74 (In Russ.)].
5. Schmahmann JD. Vascular syndromes of the thalamus. Stroke. 2003; 34:2264-78. https://doi.org/10.1161/01.STR.0000087786.38997.9E
6. Lazzaro NA, Wright B, Castillo M, et al. Artery of percheron infarction: Imaging patterns and clinical spectrum. Am J Neuroradiol. 2010;31:1283-9. https://doi.org/10.3174/ajnr.A2044
7. Arauz A, Paino-Rodriguez HM, Vargas-Gonzalez JC, et al. Clinical spectrum of artery of Percheron infarct: clinical-radiological correlations. J Stroke Cerebrovasc Dis. 2014;23(5):1083–1088.
8. Jusufovic M, Thomassen L, Skjelland M. Ischaemic stroke with patent foramen ovale. TidsskrNorLaegeforen. 2014;134:180-4. doi: 10.3174/ajnr.A2044
9. Goel SS, Tuzcu EM, Shishehbor MH, et al. Morphology of the Patent Foramen Ovale in Asymptomatic Versus Symptomatic (Stroke or Transient Ischemic Attack) Patients. Am J Cardiol. 2009;103:124-9. https://doi.org/10.1016/j.amjcard.2008.08.036
10. Poulton R, Caspi A, Milne BJ, et al. Patent foramen ovale and stroke. Lancet. 2013;360:1640-5. https://doi.org/10.1016/j.jjcc.2010.05.008
11. Alsheikh-Ali AA, Thaler DE, Kent DM. Patent foramen ovale in cryptogenic stroke: Incidental or pathogenic? Stroke. 2009;40:2349-55. https://doi.org/10.1161/STROKEAHA.109.547828
12. Zhang X-L, Kang L-N, Wang L, Xu B. Percutaneous closure versus medical therapy for stroke with patent foramen Ovale: a systematic review and meta-analysis. BMC CardiovascDisord. 2018;18:45. https://doi.org/10.1186/s12872-018-0780-x
13. Boulyjenkov V. Inherited thrombophilia: Memorandum from a joint WHO/International Society on Thrombosis and Haemostasis meeting. Bull World Health Organ. 1997;75:177-89.
14. Ng KWP, Loh PK, Sharma VK. Role of Investigating Thrombophilic Disorders in Young Stroke. Stroke Res Treat. 2011;2011:1-9. https://doi.org/10.4061/2011/670138
15. Morris JG, Singh S, Fisher M. Testing for inherited thrombophilias in arterial stroke: Can it cause more harm than good? Stroke. 2010;41:2985-90. https://doi.org/10.1161/STROKEAHA.110.595199
16. Abhinand PA, Manikandan M, Mahalakshmi R, Ragunath PK. Meta-analysis study to evaluate the association of MTHFR C677T polymorphism with risk of ischemic stroke. Bioinformation. 2017;13:214-9. https://doi.org/10.6026/97320630013214
17. Hu X, Zan X, Xie Z, et al. Association Between Plasminogen Activator Inhibitor-1 Genetic Polymorphisms and Stroke Susceptibility. MolNeurobiol. 2017; 54:328-41. https://doi.org/10.1007/s12035-015-9549-8

Авторы

М.Ю. Бровко 1, Л.А. Акулкина 1, В.И. Шоломова 1, А.Ш. Янакаева 1, Л.А. Стрижаков 1, М.В. Лебедева 1, В.В. Захаров 2, А.В. Волков 3, А.В. Лазарева 3, М.А. Кинкулькина 3, Н.Н. Иванец 3, В.В. Фомин 4

1 Клиника ревматологии, нефрологии и профпатологии им. Е.М. Тареева ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
2 Клиника нервных болезней им. А.Я. Кожевникова ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
3 Клиника психиатрии им. С.С. Корсакова ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
4 Кафедра факультетской терапии №1 лечебного факультета ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия

________________________________________________

M.Yu. Brovko 1, L.A. Akulkina 1, V.I. Sholomova 1, A.Sh. Yanakayeva 1, L.A. Strizhakov 1, M.V. Lebedeva 1, V.V. Zakharov 3, A.V. Volkov 3, A.V. Lazareva 3, M.A. Kinkul’kina 3, N.N. Ivanets 3, V.V. Fomin 4

1E.M. Tareev Clinic of Internal Diseases, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;
2A.Ya. Kozhevnikov Clinic of Nervous Diseases, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;
3S.S. Korsakov Clinic of Mental Diseases, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;
4Faculty of Medicine, Chair of Internal Medicine №1, I.M. Sechenov First Moscow State Medical University, Moscow, Russia

Назад к списку

Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.