Published on:
    Journal of Cardiovascular Disease Research, 2011; 2(2):127-129
    CLINICAL CASE REPORT BASED STUDY | doi:10.4103/0975-3583.83041

    Infectious endocarditis complicated by an ischemic stroke and revealing Marfan syndrome

    Authors:

    Zouhayr Souirti1, Saïd Boujraf1,2, Nadia Charai3, Naïma Chtaou3,Faouzi Belahsen1, Ouafae Messouak1, Mohammed Messouak4

    1Clinical Neurosciences Laboratory,

    2Department of Biophysics and Clinical MRI Methods, Faculty of Medicine of Fez,

    3Department of Neurology,

    4Department of Cardiovascular surgery, University Hospital of Fez, Morocco.

    Abstract:

    Marfan syndrome is a systematic genetic disease of the connective tissue. The cardiac affection would predict the prognosis and ischemic stroke might complicate it. The purpose of this work is to discuss the mechanisms of the ischemic stroke in Marfan syndrome which have to be considered in all young patients of ischemic strokes. We report the case of a 17-year-old male patient who presented with right hemiparesis with brachio-facial dominance,hemilhypoesthesia and Broca's aphasia; these symptoms were follows by partial right somato-motor epileptic seizure.The cerebal computed tomographic (CT) scan demonstrated early sings of ischemic stroke in the left Sylvian artery. Cardiovascular examination revealed a systolic murmur in the mitral site. Marfan syndrome with infectious endocarditis complicated by ischemic stroke was diagnosed. However,the family pathological history was negative.The Marfan syndrome diagnosis was approved considering the following criteria: Ligamentous hyperlaxity, crystalline ectopia and mitral valve prolapsus with mirtal insufficiency. The patient benefited of antibiotheraphy for 4 weeks. The patient underwent sessions of motor physical theraphy and orthophonic rehabilitation. Then,cardiac surgery was carried out and valvuloplasty was performed.The surgical treatment confirmed the presence of mirtal insufficiency and prolapsus of the big mirtal valve and multiple friable anterior-posterior vegetations with broken cordage of the small mirtal valve.Replacement of the mirtal valve was achieved,and post-surgery follow-ups were simple. The diagnosis of Marfan syndrome was based on well-defined criteria.The evolution of the patient was marked by complete improvement of the cardiac and motor deficits, and disappearance of the Broca's aphasia. A fibroelastic disease such Marfan syndrome has to be considered in unexplained ischemic stroke in all young patients.Hence,the diagnosis of Marfan syndrome involves an anticipation of the neurovascular complications by early cardiovascular care.

    Key words: Ischemic stroke, infectious endocarditis, Marfan syndrome.