Transient Ischemic Attack Associated With Mitral Systolic Clicks

Abstract

A 26-year-old woman was seen at Northwestern Memorial Hospital, Chicago, because of posterior occipital headache associated with right upper extremity paresis and dysarthria that lasted a period of ten minutes. Physical examination disclosed straightening of the thoracic spine and minimal pectus excavatum. Precordial examination showed midsystolic and late systolic clicks; the earlier click was followed by a soft grade 2/6 murmur. Neurological examination disclosed slight hyperreflexia on the right side. An M-mode echocardiogram of the mitral valve, performed the day after admission, is shown below (Fig 1). What is your diagnosis? <h3>Diagnosis.—Mitral Valve Prolapse (Barlow's Syndrome</h3> ) The patient had a normal echocardiogram, chest x-ray film, EEG, and EMI scan; results of platelet aggregation studies were also normal. A treadmill stress test was performed, which did not provoke arrhythmias. A 24-hour ambulatory ECG monitor showed slight predisposition to faster than expected resting sinus rates, but no supraventricular or ventricular arrhythmias.