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?
Diagnosis.—Mitral Valve Prolapse (Barlow's Syndrome
)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.
Saffro R, Talano JV. Transient Ischemic Attack Associated With Mitral Systolic Clicks. Arch Intern Med. 1979;139(6):693-694. doi:10.1001/archinte.1979.03630430069022