Objectives: Patent foramen ovale (PFO), migraine, and ischemic stroke are interrelated. Although PFO closure has proven to be effective for secondary prevention of ischemic stroke in patients with cryptogenic stroke, the efficacy of PFO closure for migraine has not been established. This study aimed to evaluate the prevalence and changes in migraine before and after PFO closure in patients who underwent this procedure as a secondary prevention measure for cryptogenic stroke.
Methods: Between November 2018 and March 2020, 11 consecutive patients with cryptogenic stroke who underwent transcatheter percutaneous PFO closure were enrolled and followed-up for more than six months. The diagnosis was made by a stroke neurologist, and PFO closure was performed according to relavent guidelines.
Results: Four of the 11 patients had migraine, and all showed improvement after PFO closure using the Amplatzer PFO occluder.
Conclusion: Some patients, especially those with cryptogenic stroke with PFO, may benefit from PFO closure for migraine.

View full abstract

We report a suspected case of fungal mass in the right internal jugular vein. A 70-year-old man was admitted to our hospital with heart failure. He had a persistent fever and the inflammatory response increased. Serum β-D-glucan level was elevated, and Candida albicans was identified from blood culture. He was diagnosed with a fungal infection. A central venous catheter had been inserted into the right internal jugular vein for 3weeks. The ultrasonography showed a full mass image of 6 × 5mm which was attached to a string-like organizing thrombus of approximately 25mm long in the right internal jugular vein. The echogram presented a spherical and smooth outline, and slightly heterogeneous inside of the mass with scattered vesicular structures. We attempted to retrieve a foreign body using a catheter under ultrasound guidance. However, it cannot be detached from the vessel wall. Next, surgical resection was planned under intraoperative ultrasound examination, however, the surgical procedure was not performed because his general condition deteriorated. Fortunately, the level of β-D-glucan decreased after administration of amphotericin B and the foreign body, suspected fungal mass, became smaller on ultrasonography. We experienced a suspected patient with a fungal mass in the right internal jugular vein. Ultrasonography was useful in diagnosis, treatment or follow-up.

View full abstract

A 42-year-old man with aphasia and right hemiparesis thought to be caused by a middle cerebral artery branch occlusion and consistent with an embolic stroke was referred to our hospital for further evaluation and treatment. Imaging studies failed to identify the embolic source of the stroke, although a lesion protruding into the proximal portion of the left internal artery lumen was demonstrated on carotid ultrasonography. Specifically, the protruding lesion was a crescent-shaped membranous structure however, we did not initially regard the protruding lesion as the embolic source. Therefore, he was treated with warfarin and followed in the outpatient clinic. Serial carotid ultrasonographic examinations performed at each outpatient clinic visit revealed no structural changes in the crescent-shaped membranous structure, but a thrombus distal to the membranous structure was detected 6 months after the stroke onset in spite of warfarin therapy. At that time, we determined that the protruding lesion was a carotid web and the embolic source of the stroke. He underwent a carotid endarterectomy, the warfarin was discontinued, and he has had no recurrent strokes. A carotid web is an important embolic source of an ischemic stroke, but has not been widely reported. It is essential to recognize a carotid web as a potential embolic source to prevent stroke recurrence.

View full abstract

Erratum to Japanese title, Neurosonology 2022;35:104-109.

View full abstract