Excerpt

A 44-year-old woman with multiple cerebral infarctions was referred to our echocardiography laboratory from the neurology department for an echocardiogram in search of a cardioembolic source of her strokes. She complained of hypesthesia of her left hand on the ulnar side for the last 6 weeks. Her previous history was uneventful; cardiac symptoms were denied. Her heart rate was regular and normal as was her blood pressure (115/60 mmHg). The physical examination revealed a positive left Froment’s sign. She also had a sensory defect for touch sensation in the left fourth and fifth finger. Additionally, hypesthesia of the left forefoot was detected. There was no sign of heart failure; jugular veins were unremarkable. The resting electrocardiogram showed normal sinus rhythm; in addition, during a 24 h Holter recording, no atrial fibrillation or other significant arrhythmia was found. Ambulatory blood pressure monitoring showed normotensive values with normal circadian changes. Doppler examination of the neck arteries was normal without signs of atherosclerosis. The laboratory results were unremarkable, particularly screening for coagulopathy was negative (AT III, protein S, protein C, plasminogen, APC resistance, prothrombin II GA 20210 mutation, and anticardiolipin antibodies). Magnetic resonance imaging (MRI) of the neurocranium showed defects in the posterior parietal territory on both sides and a small defect in the right posterior inferior cerebellar artery territory. There was no sign of an acute ischemia and no sign of vascular abnormality. …