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March 1983

A 'Functional Murmur' and Stroke in a Young Adult

Arch Intern Med. 1983;143(3):519-521. doi:10.1001/archinte.1983.00350030133021

A 19-year-old man had a history of a "functional murmur" since birth and transient episodes of hemiparesis that he had ignored. On Feb 16,1979, he collapsed while playing handball. He was noted to grab his neck and fall, with clonic movements of his extremities. Physical examination disclosed a thin man appearing in distress. His BP was 110/70 mm Hg, his pulse rate was 70 beats per minute and regular, and his respirations were 18/min. Positive physical findings included the cardiac examination where the apical impulse was in the fifth left intercostal space at the midclavicular line. S1 was soft, S2 was persistently split but moved physiologically. A 3/6 mid-frequency systolic ejection-type murmur at the second left intercostal space without radiation, and a 2/6 high-frequency holosystolic murmur at the apex radiating to the left sternal border were noted. The results of a neurologic examination were consistent with a right middle cerebral

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