ISPUB.COM The Internet Journal of Cardiology Volume 4 Number 1 1 of 3 Isolated large atrial septal aneurysm and multiple cerebral infarcts: Is there any association? G Gavrielatos, K Letsas, L Pappas, I Alexanian, M Efremidis, H Sioras, F Kardaras Citation G Gavrielatos, K Letsas, L Pappas, I Alexanian, M Efremidis, H Sioras, F Kardaras. Isolated large atrial septal aneurysm and multiple cerebral infarcts: Is there any association?. The Internet Journal of Cardiology. 2006 Volume 4 Number 1. Abstract An atrial septal aneurysm (ASA) is a thin, localized saccular deformity of the atrial septum that bulges into the right or left atrium. Diagnosis can be established using transthoracic (TTE) and transesophageal (TEE) echocardiography. Although these abnormalities are considered clinically benign entities, they have been independently associated with ischemic stroke. The case of a large atrial septal aneurysm in a patient with transient ischemic attack and previous undiagnosed cerebral infarcts is described in the present report. CASE PRESENTATION A 60 year old woman with no medical history presented in the emergency department for presyncope evaluation. She reported generalised weakness, dizziness, sudden occurrence of vision disturbances, and transient dysphasia. Neurological signs and symptoms gradually improved over a period of 20 minutes. Consciousness was never impaired and there were no other symptoms. Physical examination following the episode revealed body temperature 36,6° C, a mid systolic murmur, best heard at the apex. No evidence of arterial hypertension or arrhythmias was found. She did not exhibit any postural changes of arterial blood pressure or pulse. Electrocardiogram showed sinus rhythm with LBBB pattern. Chest X-ray was normal. Laboratory findings including CK- MB and cardiac troponin T, as well as coagulopathy screening presented no abnormalities. Carotid ultrasound Doppler examination, electroencephalography and routine 48-hour ambulatory (Holter) ECG were normal. Brain computer tomography (CT) scan showed old ischemic infarcts at the cerebral stem and basal ganglia, as well as microinfarcts of the cerebral cortex, located at the right temporal lobe. Doppler echocardiography of the lower extremities excluded deep vein thrombosis. A clinical diagnosis of transient ischemic attack was established. Transthoracic echocardiography revealed a large atrial septal aneurysm (Fig. 1). Figure 1 Figure 1: Four chamber view on TTE study revealed a large atrial septal aneurysm bulging into right atrium during cardiac systole. According to Hanley's diagnostic criteria, atrial septum considered to be aneurysmal, when a dilated segment protruded at least 15 mm beyond the level surface of the atrial septum 1 . An echo contrast study was also performed in order to exclude patent foramen ovale. The images recorded were not diagnostic of right to left shunting. A transesophageal echocardiography was recommended but the patient denied further evaluation, when she was informed with details the examination procedure. The patient was started on anticoagulation treatment with warfarin. She improved and was discharged from hospital a week after admission with no neurological deficit.