PS-R06-3: A CASE OF CEREBRAL INFARCTION IN AN ELDERLY HYPERTENSIVE PATIENT WITH 24-HOUR STRICT BLOOD PRESSURE CONTROL

Abstract

Introduction: In elderly patients, hypertension is a major risk factor of stroke. Therefore, strict blood pressure (BP) control provides most effective for the prevention of stroke incidence. Here, we report the case of stroke occurred under strict BP control in an elderly patient. Case: A 80-year-old Japanese women with the treatment of hypertension and dyslipidemia was admitted to our hospital with suddenly vertigo. Before admission, her BP control was controlled, which her ambulatory BP monitoring performed three months prior to admission showed that 24-hour, daytime and nighttime BP were 107/61 mmHg, 112/64 mmHg and 94/53 mmHg, respectively, and diurnal BP variation showed dipper pattern. On admission, her electrocardiography showed sinus rhythm, and her head magnetic resonance imaging showed the bilateral cerebellum infarction, which is the area dominated by posterior inferior cerebellar artery. The D-dimer level was 1.2 μg/ml. Transesophageal echocardiography was performed to search for an embolic source of stroke and revealed a patent foramen ovale (PFO). Leg vein echocardiography showed the thrombus in the bilateral soleus veins. Based on the above results, we diagnosed a paradoxical cerebral embolism caused by deep vein thrombosis of the lower extremities and PFO. Conclusion: The patient had achieved strict BP control assessed by ABPM prior to the onset of the stroke and was considered to be at low risk of stroke. Paradoxical cerebral embolism is a common cause of stroke in younger patients, however, physicians should be also noted as a cause of cerebral infarction even in the elderly patients.