r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2025-30-2-22-26r-n-j-682Research ArticleИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL RESEARCHES AND CASE REPORTSТранзиторная глобальная амнезия на фоне редкой аномалии сердцаTransient global amnesia due to a rare cardiac anomalyhttps://orcid.org/0000-0001-5679-4100МехряковС. А.MehryakovS. A.

Пермь

Perm

heartolog@gmail.comhttps://orcid.org/0000-0001-6061-8118КулешА. А.KuleshA. A.

Пермь

Perm

aleksey.kulesh@gmail.comhttps://orcid.org/0000-0002-3785-1154КайлеваН. А.KailevaN. A.

Пермь

Perm

kaileva@yandex.ruhttps://orcid.org/0009-0000-8975-7365КрапивинС.KrapivinS.

Пермь

Perm

sergejs.krap0001@gmail.comФГАОУ ВО «Пермский государственный медицинский университет имени академика Е.А. Вагнера» Минздрава РоссииРоссияPerm State Medical University named after Academician E. A. WagnerRussian Federation2025100620253022226Copyright © Мехряков С.А., Кулеш А.А., Кайлева Н.А., Крапивин С., 20252025Мехряков С.А., Кулеш А.А., Кайлева Н.А., Крапивин С.Mehryakov S.A., Kulesh A.A., Kaileva N.A., Krapivin S.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/682Введение

Введение. Септальный мешочек левого предсердия (СМЛП) является редкой малоизученной причиной эмболического криптогенного инсульта. Наряду с этим отсутствует понимание роли данной аномалии в развитии транзиторной глобальной амнезии (ТГА).

Цель

Цель. Представить клиническое наблюдение пациента с транзиторной глобальной амнезией и левопредсердным септальным мешочком.

Материал и методы

Материал и методы. В статье описан клинический случай молодой пациентки с ТГА и сочетанной аномалией межпредсердной перегородки в виде СМЛП и открытого овального окна (ООО). С целью поиска опубликованных случаев и обзоров на тему патогенетической значимости СМЛП проанализирована база данных медицинских и биологических публикаций PubMed.

Результаты

Результаты. Пациентка с мигренью в анамнезе на фоне провоцирующих факторов (маневр Вальсальвы) перенесла эпизод ТГА. Ангиовизуализация не выявила патологии. Острых инфарктов по данным магнитно-резонансной томографии не было. В ходе диагностического поиска при проведении чреспищеводной эхокардиографии выявлена комбинированная аномалия межпредсердной перегородки в виде сочетания СМЛП и ООО. При анализе литературы нами не было найдено описанных случаев сочетания СМЛП с ООО.

Заключение

Заключение. СМЛП является редкой и малоизученной аномалией формирования межпредсердной перегородки. Диагностическим методом выбора является чреспищеводная эхокардиография. При подозрении на наличие СМЛП необходимо исключение сопутствующих межпредсердных сообщений с помощью баббл-теста. СМЛП может играть роль в развитии ТГА, однако данный вопрос требует дальнейшего изучения.

Introduction

Introduction. Left atrial septal pouch (LASP) is a rare, poorly understood cause of embolic cryptogenic stroke. Along with this, there is no understanding of the role of this pathology in the development of transient global amnesia (TGA) due to possible embolism.

Aim

Aim. To present a clinical case of a patient with TGA and LASP.

Material and methods

Material and methods. This article presents a description of the clinical case of a young patient with TGA and a concomitant anomaly of the interatrial septum in the form of LASP and patent foramen ovale (PFO). In order to search for published clinical cases and reviews on the pathogenetic significance of LASP, the database of medical and biological publications PubMed was analyzed.

Results

Results. Patient O., 39-year old, with a history of migraine due to provoking factors (Valsalva maneuver), suff ered an episode of TGA. Angiography did not reveal any pathology. There were no acute infarctions according to magnetic resonance imaging. During the diagnostic search, transesophageal echocardiography revealed a combined anomaly of the interatrial septum in the form of a combination of LASP with PFO.

Conclusion

Conclusion. LASP is a rare and little-studied anomaly of the formation of the interatrial septum. Transthoracic echocardiography is not a sensitive method for identifying this pathology. The imaging method of choice is TEE. If the presence of LASP is suspected, clinicians should be aware of the need to exclude concomitant interatrial communications using a bubble study.

септальный мешочек левого предсердияоткрытое овальное окнотранзиторная глобальная амнезияцеребральная эмболияэхокардиографияleft atrial septal pouchpatent foramen ovaletransient global amnesiacerebral embolismechocardiographyReferencesКулеш АА, Демин ДА, Белопасова АВ, Мехряков СА, Виноградов ОИ, Сыромятникова ЛИ, Зеньков АА. Криптогенный инсульт. Часть 2: парадоксальная эмболия. Медицинский Совет. 2021;(19):16−33. doi:10.21518/2079-701X-2021-19-16-33.Kulesh AA, Demin DA, Belopasova AV, Mekhryakov SA, Vinogradov OI, Syromyatnikova LI, Ziankou AA. Cryptogenic stroke. Part 2: paradoxical embolism. Meditsinskiy sovet = Medical Council. 2021;(19):16−33. doi:10.21518/2079-701X-2021-19-16-33. (In Russ.)Ишемический инсульт: диагностика, лечение, реабилитация и профилактика. Руководство для врачей / О.И. Виноградов, А.А. Кулеш, Д.А. Демин. М.: Логосфера, 2024. 256 с.Ischemic stroke: diagnosis, treatment, rehabilitation and prevention. A guide for doctors / O.I. Vinogradov, A.A. Kulesh, D.A. Demin. Moscow: Logosphere, 2024. 256 p. (In Russ.)Wong JM, Lombardo DM, Barseghian A, Dhoot J, Hundal HS, Salcedo J, Paganini-Hill A, Wong ND, Fisher M. Left atrial septal pouch in cryptogenic stroke. Front Neurol. 2015 Mar 24;6:57. doi: 10.3389/fneur.2015.00057Wong JM, Lombardo DM, Barseghian A, Dhoot J, Hundal HS, Salcedo J, Paganini-Hill A, Wong ND, Fisher M. Left atrial septal pouch in cryptogenic stroke. Front Neurol. 2015 Mar 24;6:57. doi: 10.3389/fneur.2015.00057Farooqi P, Yaqobi A, Mia Khail B, Niño Medina JA, Obaid Ullah Z, Saeed A, Alamy H, Farooqi SA, Azizi N, Duarte LE, Ghani T, Aminpoor H. Left Atrial Septal Pouch (LASP) and Cryptogenic Stroke: A Narrative Review. Cureus. 2024 Jul 10;16(7):e64245. doi: 10.7759/cureus.64245Farooqi P, Yaqobi A, Mia Khail B, Niño Medina JA, Obaid Ullah Z, Saeed A, Alamy H, Farooqi SA, Azizi N, Duarte LE, Ghani T, Aminpoor H. Left Atrial Septal Pouch (LASP) and Cryptogenic Stroke: A Narrative Review. Cureus. 2024 Jul 10;16(7):e64245. doi: 10.7759/cureus.64245Amin A, Augustine M, Shafique MA, Mustafa MS, Mian ZR, Jaimes DCC, Gaudani A, Shaukat B, Kumar S, Aulakh SS, Jami E, Sharifa M, Ahuja K, Maslamani ANJ, Bhudia S. Left Atrial Septal Pouch (LASP) and cryptogenic stroke risk: An updated systematic review and meta-analysis of observational studies. Curr Probl Cardiol. 2024;49(3):102400. doi: 10.1016/j.cpcardiol.2024.102400Amin A, Augustine M, Shafique MA, Mustafa MS, Mian ZR, Jaimes DCC, Gaudani A, Shaukat B, Kumar S, Aulakh SS, Jami E, Sharifa M, Ahuja K, Maslamani ANJ, Bhudia S. Left Atrial Septal Pouch (LASP) and cryptogenic stroke risk: An updated systematic review and meta-analysis of observational studies. Curr Probl Cardiol. 2024;49(3):102400. doi: 10.1016/j.cpcardiol.2024.102400Kapoor R, Wadi L, Becerra B, Eskander M, Razmara A, Lombardo D, Paganini-Hill A, Kim JK, Fisher M. The left atrial septal pouch: a new stroke risk factor? Transl Stroke Res. 2021;12(2):205−211. doi:10.1007/s12975-020-00864-3Kapoor R, Wadi L, Becerra B, Eskander M, Razmara A, Lombardo D, Paganini-Hill A, Kim JK, Fisher M. The left atrial septal pouch: a new stroke risk factor? Transl Stroke Res. 2021;12(2):205−211. doi:10.1007/s12975-020-00864-3Кулеш АА, Дёмин ДА, Кайлева НА, Мехряков СА, Крапивин СВ. Транзиторная глобальная амнезия. Неврология, нейропсихиатрия, психосоматика. 2024;16(2):4–13. doi: 10.14412/2074-2711-2024-2-4-13Kulesh AA, Demin DA, Kayleva NA, Mekhryakov SA, Krapivin SV. Transient global amnesia. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2024;16(2):4−13. doi: 10.14412/2074-2711-2024-2-4-13.(In Russ.)Klötzsch C, Sliwka U, Berlit P, Noth J. An increased frequency of patent foramen oval in patients with transient global amnesia. Analysis of 53 consecutive patients. Arch Neurol. 1996 Jun;53(6):504–8. doi: 10.1001/archneur.1996.00550060046014Klötzsch C, Sliwka U, Berlit P, Noth J. An increased frequency of patent foramen oval in patients with transient global amnesia. Analysis of 53 consecutive patients. Arch Neurol. 1996 Jun;53(6):504–8. doi: 10.1001/archneur.1996.00550060046014Noh SM, Kang HG. Clinical manifestation and imaging characteristics of transient global amnesia: patent foramen ovale as an underlying factor. J Integr Neurosci. 2021;30;20(3):719−725. doi: 10.31083/j.jin2003077Noh SM, Kang HG. Clinical manifestation and imaging characteristics of transient global amnesia: patent foramen ovale as an underlying factor. J Integr Neurosci. 2021;30;20(3):719−725. doi: 10.31083/j.jin2003077Krishnan SC, Salazar M. Septal pouch in the left atrium: a new anatomical entity with potential for embolic complications. JACC Cardiovasc Interv. 2010;3(1):98−104. doi: 10.1016/j.jcin.2009.07.017Krishnan SC, Salazar M. Septal pouch in the left atrium: a new anatomical entity with potential for embolic complications. JACC Cardiovasc Interv. 2010;3(1):98−104. doi: 10.1016/j.jcin.2009.07.017Mazur M., Jasinska K., Walocha J. The morphology, clinical significance and imaging methods of the atrial septal pouch: A critical review. Translational Research in Anatomy. 2018;13. doi:10.1016/j.tria.2018.11.002Mazur M., Jasinska K., Walocha J. The morphology, clinical significance and imaging methods of the atrial septal pouch: A critical review. Translational Research in Anatomy. 2018;13. doi:10.1016/j.tria.2018.11.002Wong JM, Lombardo D, Handwerker J, Fisher M. Cryptogenic stroke and the left atrial septal pouch: a case report. J Stroke Cerebrovasc Dis. 2014;23(3):564−5. doi: 10.1016/j.jstrokecere-brovasdis.2013.04.009Wong JM, Lombardo D, Handwerker J, Fisher M. Cryptogenic stroke and the left atrial septal pouch: a case report. J Stroke Cerebrovasc Dis. 2014;23(3):564−5. doi: 10.1016/j.jstrokecere-brovasdis.2013.04.009Elsayed M, Hsiung MC, Meggo-Quiroz LD, Elguindy M, Uygur B, Tandon R, Guvenc T, Keser N, Vural MG, Bulur S, Chahwala JR, Abtahi F, Nanda NC. Incremental Value of Live/ Real Time Three-Dimensional over Two-Dimensional Transesophageal Echocardiography in the Assessment of Atrial Septal Pouch. Echocardiography. 2015;32(12):1858−67. doi: 10.1111/echo.13111Elsayed M, Hsiung MC, Meggo-Quiroz LD, Elguindy M, Uygur B, Tandon R, Guvenc T, Keser N, Vural MG, Bulur S, Chahwala JR, Abtahi F, Nanda NC. Incremental Value of Live/ Real Time Three-Dimensional over Two-Dimensional Transesophageal Echocardiography in the Assessment of Atrial Septal Pouch. Echocardiography. 2015;32(12):1858−67. doi: 10.1111/echo.13111Tugcu A, Okajima K, Jin Z, Rundek T, Homma S, Sacco RL, Elkind MS, Di Tullio MR. Septal pouch in the left atrium and risk of ischemic stroke. JACC Cardiovasc Imaging. 2010;3(12):1276−83. doi: 10.1016/j.jcmg.2010.11.001Tugcu A, Okajima K, Jin Z, Rundek T, Homma S, Sacco RL, Elkind MS, Di Tullio MR. Septal pouch in the left atrium and risk of ischemic stroke. JACC Cardiovasc Imaging. 2010;3(12):1276−83. doi: 10.1016/j.jcmg.2010.11.001de Abreu Junior L, de Godoy LL, Vaz LPDS, Torres AE, Wolosker AMB, Torres US, Borri ML. Optimization of magnetic resonance imaging protocol for the diagnosis of transient global amnesia. Radiol Bras. 2019;52(3):161−165. doi: 10.1590/0100-3984.2018.0028de Abreu Junior L, de Godoy LL, Vaz LPDS, Torres AE, Wolosker AMB, Torres US, Borri ML. Optimization of magnetic resonance imaging protocol for the diagnosis of transient global amnesia. Radiol Bras. 2019;52(3):161−165. doi: 10.1590/0100-3984.2018.0028Noh SM, Kang HG. Clinical manifestation and imaging characteristics of transient global amnesia: patent foramen ovale as an underlying factor. J Integr Neurosci. 2021;30;20(3):719−725. doi: 10.31083/j.jin2003077Noh SM, Kang HG. Clinical manifestation and imaging characteristics of transient global amnesia: patent foramen ovale as an underlying factor. J Integr Neurosci. 2021;30;20(3):719−725. doi: 10.31083/j.jin2003077Hołda MK, Krawczyk-Ożóg A, Koziej M, Sorysz D, Hołda J, Dudek D, Klimek-Piotrowska W. Left-Sided Atrial Septal Pouch is a Risk Factor for Cryptogenic Stroke. J Am Soc Echocardiogr. 2018;31(7):771−776. doi: 10.1016/j.echo.2018.01.023Hołda MK, Krawczyk-Ożóg A, Koziej M, Sorysz D, Hołda J, Dudek D, Klimek-Piotrowska W. Left-Sided Atrial Septal Pouch is a Risk Factor for Cryptogenic Stroke. J Am Soc Echocardiogr. 2018;31(7):771−776. doi: 10.1016/j.echo.2018.01.023Ferreira E, Cavalcanti de Oliveira D, Braga Barros A, Fuks V, Salgado ÂA, José Montenegro da Costa M, Cristine Marques Dos Santos S, Aragão I, Bueno Castier M, Kohn L, Mourilhe-Rocha R, Albuquerque FN, Esporcatte R, Campos de Albuquerque D. Left Atrial Septal Pouch and Acute Thromboembolic Ischemia of the Upper Limb. Am J Case Rep. 2021;20;22:e932582. doi: 10.12659/AJCR.932582Ferreira E, Cavalcanti de Oliveira D, Braga Barros A, Fuks V, Salgado ÂA, José Montenegro da Costa M, Cristine Marques Dos Santos S, Aragão I, Bueno Castier M, Kohn L, Mourilhe-Rocha R, Albuquerque FN, Esporcatte R, Campos de Albuquerque D. Left Atrial Septal Pouch and Acute Thromboembolic Ischemia of the Upper Limb. Am J Case Rep. 2021;20;22:e932582. doi: 10.12659/AJCR.932582Goertz L, Nelles C, Pennig L, Bunck AC, Reimer RP, Fervers P, Kabbasch C, Maintz D, Celik E. Association between pouch morphology, cardiovascular risk factors and ischemic brain lesions in patients with left-sided septal pouches. Clin Imaging. 2023;100:36−41. doi: 10.1016/j.clinimag.2023.04.014Goertz L, Nelles C, Pennig L, Bunck AC, Reimer RP, Fervers P, Kabbasch C, Maintz D, Celik E. Association between pouch morphology, cardiovascular risk factors and ischemic brain lesions in patients with left-sided septal pouches. Clin Imaging. 2023;100:36−41. doi: 10.1016/j.clinimag.2023.04.014Khan A, Riasat M, Ehtesham M, Brink D, Rai K, Haseeb M, Khan W, Zein R. Recurrent Cryptogenic Stroke in a Patient With Left Atrial Septal Pouch. Cureus. 2022;18;14(4):e24241. doi: 10.7759/cureus.24241Khan A, Riasat M, Ehtesham M, Brink D, Rai K, Haseeb M, Khan W, Zein R. Recurrent Cryptogenic Stroke in a Patient With Left Atrial Septal Pouch. Cureus. 2022;18;14(4):e24241. doi: 10.7759/cureus.24241Hołda MK, Krawczyk-Ożóg A, Koziej M, Sorysz D, Hołda J, Dudek D, Klimek-Piotrowska W. Mid-esophageal bicaval versus short-axis view of interatrial septum in two-dimensional transesophageal echocardiography for diagnosis and measurement of atrial septal pouches. Echocardiography. 2018;35(6):827−833. doi: 10.1111/echo.13847Hołda MK, Krawczyk-Ożóg A, Koziej M, Sorysz D, Hołda J, Dudek D, Klimek-Piotrowska W. Mid-esophageal bicaval versus short-axis view of interatrial septum in two-dimensional transesophageal echocardiography for diagnosis and measurement of atrial septal pouches. Echocardiography. 2018;35(6):827−833. doi: 10.1111/echo.13847Hołda MK, Krawczyk-Ożóg A, Koziej M, Pawlik W, Sorysz D, Wszołek K, Dudek D, Klimek-Piotrowska W. Cardiac computed tomography compared with two-dimensional transesophageal echocardiography for the detection and assessment of atrial septal pouches. Int J Cardiovasc Imaging. 2018;34(8):1305−1313. doi: 10.1007/s10554-018-1342-0Hołda MK, Krawczyk-Ożóg A, Koziej M, Pawlik W, Sorysz D, Wszołek K, Dudek D, Klimek-Piotrowska W. Cardiac computed tomography compared with two-dimensional transesophageal echocardiography for the detection and assessment of atrial septal pouches. Int J Cardiovasc Imaging. 2018;34(8):1305−1313. doi: 10.1007/s10554-018-1342-0Gerçek M, Hata M, Gummert J, Rudolph V, Friedrichs KP. Interatrial Thrombus in Left-Atrial Septal Pouch Prohibiting Transseptal Puncture for Percutaneous Mitral Valve Therapy. CJC Open. 2021 Jan 30;3(6):835−837. doi: 10.1016/j.cjco.2021.01.011Gerçek M, Hata M, Gummert J, Rudolph V, Friedrichs KP. Interatrial Thrombus in Left-Atrial Septal Pouch Prohibiting Transseptal Puncture for Percutaneous Mitral Valve Therapy. CJC Open. 2021 Jan 30;3(6):835−837. doi: 10.1016/j.cjco.2021.01.011Zhang W, Cheng Z, Fu F, Zhan Z. Prevalence and clinical characteristics of white matter hyperintensities in Migraine: A meta-analysis. Neuroimage Clin. 2023;37:103312. doi: 10.1016/j.nicl.2023.103312Zhang W, Cheng Z, Fu F, Zhan Z. Prevalence and clinical characteristics of white matter hyperintensities in Migraine: A meta-analysis. Neuroimage Clin. 2023;37:103312. doi: 10.1016/j.nicl.2023.103312

The authors declare that there are no conflicts of interest present.