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MIGRAINE AND PATENT FORAMEN OVALE - CASE REPORT
(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2023)
Deleva Stoshevska, Tatjana
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Nikoloska, Sofija
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Nikoloski, Marko
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Stoshevski, Bojan
AbstractMigraine is a headache disorder, typically characterized by unilateral headache (with or without aura) of pulsating quality, which is associated with nausea, phonophobia and photophobia. The patent foramen ovale (PFO) is a remnant of the fetal circulation. Multiple studies suggest that migraine is more prevalent in subjects with PFO and vice versa, suggesting that PFO and migraine may be risk factors for each other.Case report.We present a 33-year-old female patient with unilateralhemicranialheadache,mostly on the right side, pain in the right eye, nausea, vomiting, photo and phonophobia, with previous visual difficulties with the ipsilateral eye. The complaints usually lasted2-3 days and wereassociatedmostly with the menstrual cycle. Therewerealso occasional bouts of dizziness. Ophthalmological and otorhinolaryngological nature of these complaints wasexcluded with additional investigations. In addition, nuclear magnetic resonance (NMR)of the brain, color Doppler duplex sonography(CDDS)of carotid and vertebral arteries were performed, all with normal findings. On transcranial color Doppler sonography with Bubble test, a positive finding was obtained for a Grade 4 right-left shunt and the patient was referred for cardiology assessment and evaluation. The patient was diagnosed with migraine with aura (visual) and PFO.Conclusion.Results from epidemiological studies examining the relationship between PFO and migraine are mixed at best. It is unclear if there is a causal relationship or simply a co-existence of these two conditions. Moreresearch of PFO in migraine is clearly needed before we can consider changing our views on the aforementioned conclusions.Keywords:migraine, patent foramen ovale.
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A young female adult patient with an ischaemic stroke and patent foramen ovale: a case report and literature review
(Croatian Academy of Sciences and Arts – Medical Sciences, 2022-06-30)
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Strokes in young adults are relatively rare. We present a 36-year old female patient, who came to the urgent neurological outpatient office of the Clinic for neurology due to symptoms presented two hours prior to the examination. The symptoms consisted of inability to move the left arm, partial motor weakness of the left leg, slurred speech and difficulty swallowing. The urgent CT scan result was normal. Despite the fulfilled conditions, thrombolysis was not possible. Brain MRI results revealed a small hypersignal lesion in FLAIR with diffusion restriction on the right, cortically to subcortically, in gyrus praecentralis. The genetic testing for cardiovascular diseases showed that the patient is a homozygote for the mutation C677T (OMIM® 607093.0003) in the gene for methylenetetrahydrofolate reductase (MTHFR) and heterozygote for the mutations eNOS G894T and LTA. The following gene polymorphisms were typed: PAI 5G/4G, HPA1 1b/1a, ACE deletion/insertion, EPCR A4600G A/A, EPCR G4678C C/G and APOE E3/E4. Trans-esophageal echocardiography discovered an aneurysm of the interatrial septum, with a present PFO channel, with a diameter of 6.8 mm. The bubble test was positive, and there were no visible thrombi in the left auricle. The cardiologist recommended closing of the PFO with a device and therapy with acetylsalicylic acid. The cause of the stroke was found and measures for secondary prevention were taken. The patient has returned to her work and private obligations. She upholds neurological consultations regularly and her recovery is closely observed.
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Right bundle branch block as a marker for interatrial septal abnormalities
(Cambridge University Press, 2012-02)
Bakalli, A
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Kocinaj, D
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Bekteshi, T
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Pilana, E
Background: Interatrial septal anomalies, which include atrial septal defect, patent foramen ovale, and atrial septal aneurysm, are common disorders among adult patients. Early detection of interatrial septal anomalies is important in order to prevent haemodynamic consequences and/or thromboembolic events. Electrocardiogram offers some clues that should serve as hints for detection of interatrial abnormalities. The aim of our study was to analyse the interatrial septum by transoesophageal echocardiography in patients with electrocardiogram signs of right bundle branch block and in those without right bundle branch block. Methods and results: In a prospective study, 87 adult patients were included, that is, 41 with electrocardiogram signs of right bundle branch block forming the first group and 46 without right bundle branch block forming the second group. Interatrial septal anomalies were present in 80.5% of the patients with right bundle branch block, with patent foramen ovale (39.02%) being the most prevalent disorder, followed by atrial septal aneurysm (21.9%) and atrial septal defect (19.5%). Interatrial septal abnormalities were significantly more frequent in the first group compared with the second group (80.5% versus 6.5%, p value less than 0.001). Independently, patent foramen ovale was significantly more prevalent in patients with right bundle branch block (39.02% versus 4.3%, p value less than 0.001), as were atrial septal aneurysm (21.9% versus 2.2%, p value equal 0.01) and atrial septal defect (19.5% versus 0%, p value equal 0.004). Conclusions: Right bundle branch block should serve as a valuable indicator to motivate a detailed search for interatrial septal abnormalities.

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