case_images: PMC11755524_01
case_images: The patient's brain magnetic resonance imaging (MRI) series. (A) This is an apparent diffusion coefficient (ADC) image of the patient's brain, which did not reveal any acute intracranial lesion. (B) This is a diffusion-weighted image (DWI) image of the patient's brain, which did not reveal any acute intracranial lesion.
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case_images: An initial, non-contrast computed tomography (CT) of the brain did not reveal any acute intracranial finding, which was swiftly followed by magnetic resonance imaging and angiography (MRI/MRA), which also revealed no significant abnormalities within the visualized intracranial vasculature with no evidence of arteriovenous malformation (AVM) or aneurysm (Figure 1).
case_images: The patient's 2- and 3-dimensional transesophageal echocardiogram displays the Hurwitz-Roberts class A and Nakamura type I quadricuspid aortic valve (QAV).. The leaflets display an "X" configuration during diastole and a "square" configuration during systole.
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case_images: AR, evidenced by a prolonged pressure half-time of 460 ms (Figures 2 and 3).
case_images: The patient's 2-dimensional transthoracic (2D-TTE) echocardiogram. (A) The parasternal short-axis view (zoomed in on the aortic valve) displays the Hurwitz-Roberts class A and Nakamura type I quadricuspid aortic valve (QAV). The leaflets display an "X" configuration during diastole and a "square" configuration during systole. (B) The parasternal long axis (zoomed in on the aortic valve) view displays the Hurwitz-Roberts class A and Nakamura type I quadricuspid aortic valve (QAV). Color flow Doppler interrogation revealed a central regurgitant jet indicative of moderate aortic regurgitation, evidenced by a prolonged pressure half-time of 460 ms.
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case_images: AR, evidenced by a prolonged pressure half-time of 460 ms (Figures 2 and 3).
case_images: The patient's transesophageal (TEE) echocardiogram. (A) A short-axis (zoomed in on the aortic valve) view displaying the Hurwitz-Roberts class A and Nakamura type I quadricuspid aortic valve (QAV) in an open position. (B) A short-axis (zoomed in on the aortic valve) view displaying the Hurwitz-Roberts class A and Nakamura type I quadricuspid aortic valve (QAV) in a closed position. There is evidence of mild sclerosis and calcification. (C) A view of the interatrial septum demonstrating no patent foramen ovale, atrial septal defect, or bubble contrast in both left and right atria soon after injection.
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case_images: A transesophageal echocardiogram also reflected similar valvular findings, with no patent foramen ovale or atrial septal defect observed (Figure 4). A 24-hour Holter monitor did not reveal any atrial fibrillation (AF) or advanced heart block.