“Ictus en paciente jóven secundario a una valvulopatía mitral”

Abstract

Stroke is defined as cerebral involvement (permanent or transient) secondary to ischemia or bleeding from damage to the blood vessels in the brain. The incidence of stroke is estimated at around 6-20 cases per 100,000 inhabitants per year. There are no epidemiological studies in Ecuador. In the young adult patient (15-45 years) is a rare but not exceptional entity being the first cause of disability and the second cause of dementia and death worldwide. In younger patients the disease causes a longer period of disability and condition in the quality of life. The prognosis is favorable, requiring an extensive and individualized study, assessing the presence of data that can guide and determine the etiology. Its importance is that when knowing the mechanism that causes this disease, it will be possible to carry out an adequate treatment and an effective secondary prevention.

We report the case of a 30-year-old female patient with no personal history, a family history of a father with type 2 diabetes mellitus, a history of gynecological obstetrics 2, childbirth 1, and abortion 1, who presented with clinical manifestations of altered consciousness followed by neurological defficit of 7 hours of evolution. Physical examination revealed motor aphasia, right larval hemiparesis. A simple nuclear magnetic resonance imaging (MRI) scan was performed in which hypointense images were observed in the left parietal level and in the right thalamus where it was evident congruent with areas of acute infarction. During admission to the hospital, ANA, ANCA and LE cells were tested: negative; Serological for lues and human immunodeficiency virus (HIV): negative; Blood chemistry and blood count: normal; Coagulation times: normal; Blood gases: Normal, BHCG: negative; normal EKG, echocardiogram with a result of Severe mitral stenosis of possible rheumatic origin. We did not perform the cerebral vascular imaging test (Angiotac), toxicological that were not managed. Antiepileptic treatment with phenytoin 100mg 1 tablet VO QD was evaluated in the first week, showing relative remission. In the second week it starts with antiplatelet ASA 100mg VO QD until its egress. After analyzing the data obtained in the medical history, physical examination and complementary studies we conclude that we are in the presence of a stroke in a young patient and the cause is a highly embolic cardiomyopathy (severe mitral stenosis of rheumatic origin), which unfortunately was not detected early until it produced the neurological complication previously manifested.