The patient was a 78-year-old man. He was transferred to the emergency room presenting with
aphasia and right
hemiplegia. Head CT and CT angiography demonstrated a narrow territory of early ischemic signs and occlusion of the horizontal segment of the left middle cerebral artery (MCA), respectively. Endovascular
thrombectomy was performed and complete recanalization of MCA was achieved. After admission, transthoracic echocardiography revealed a cystic mass near the left coronary apex of the aortic valve, which was diagnosed as an
aneurysm of the sinus of Valsalva (ASV) by contrast-enhanced chest computed tomography. Transesophageal echocardiography showed a severe
smoke-like echo within ASV, despite being in sinus rhythm. Intravenous
anticoagulant therapy was started, and patch closure was performed by cardiovascular surgeons on the 13th day despite of early period after
stroke onset. During the operation, no
thrombus was seen around the inlet of ASV. On the two days after the operation,
paroxysmal atrial fibrillation was detected and
anticoagulant therapy was continued. In this patient, ASV was regarded as the embolic source of
cerebral embolism, and
anticoagulant therapy and surgical intervention were selected in the early period after
stroke onset to prevent
embolism recurrence, resulting in a favorable
clinical course.