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Acute paradoxical embolic cerebral ischemia secondary to possible May-Thurner syndrome and an atrial septal defect: a case report

Richard A Rison* and Matthew D Helfgott

Author Affiliations

Los Angeles County Medical Center, PIH Health Stroke Program, University of Southern California Keck School of Medicine, 12401 Washington Blvd., Whittier, CA 90602, USA

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Journal of Medical Case Reports 2013, 7:172  doi:10.1186/1752-1947-7-172

Published: 3 July 2013



May-Thurner syndrome is an anatomic abnormality that predisposes patients to increased risk of paradoxical embolism and stroke. It consists of chronic compression of the left common iliac vein by the overlying right common iliac artery which may predispose to local thrombus formation, which in turn may be the nidus of a paradoxical embolus leading to cerebral ischemia in patients with a right-to-left shunt secondary to an atrial septal defect or patent foramen ovale.

Case presentation

We report the case of an embolic cerebral ischemic event in a 53-year-old Caucasian woman whose investigations revealed findings suggestive of possible May-Thurner syndrome coupled with an atrial septal defect. Her atrial septal defect was closed, she was placed on aspirin therapy, and has not had any recurrent events.


May-Thurner syndrome is an important consideration in patients with paradoxical embolic cerebral ischemia and atrial septal defects.