Clinical Report: May-Thurner Syndrome: An Underlying Cause of Ischemic Stroke in Younger Adults

Overview

Expand on the connection between MTS and ASD, particularly how they contribute to stroke risk.

Background

Stroke in young adults often poses a diagnostic challenge due to the absence of traditional risk factors, with many cases remaining cryptogenic. May-Thurner syndrome, characterized by the compression of the left iliac vein by the right iliac artery, is a significant but underrecognized cause of venous thromboembolism that can lead to serious complications, including ischemic stroke. Understanding MTS is crucial for timely diagnosis and management in younger patients presenting with stroke.

Data Highlights

Key Findings

• May-Thurner syndrome is estimated to account for 2-5% of all DVTs.
• Significant left common iliac vein compression occurs in approximately 24% of asymptomatic individuals.
• The patient presented with right-sided weakness and aphasia, indicative of ischemic stroke.
• Comprehensive hypercoagulable workup was negative, highlighting the need for anatomical evaluations.
• Triptans were discontinued due to their vasoconstrictive properties, and propranolol was initiated for migraine prophylaxis.

Clinical Implications

Healthcare providers should consider anatomical variants like MTS in young patients presenting with ischemic stroke, especially when traditional risk factors are absent. A thorough cardiovascular evaluation, including imaging studies, is essential for accurate diagnosis and management.

Conclusion

This case underscores the importance of recognizing May-Thurner syndrome as a potential cause of ischemic stroke in younger adults, which can significantly impact treatment and prevention strategies.

References

1. European Stroke Organisation (ESO) Guidelines on the diagnosis and management of patent foramen ovale (PFO) after stroke - Valeria Caso et al., 2024
2. May-Thurner Syndrome - StatPearls - NCBI Bookshelf
3. European Journal of Preventive Cardiology — Atherosclerotic Cardiovascular Disease in Younger Populations: An Emerging Concern
4. European Journal of Preventive Cardiology — Arterial cardiovascular disease risk after venous thromboembolism in young adults: a Danish nationwide cohort study
5. European Journal of Preventive Cardiology — Accelerated ageing predicts earlier onset of ischaemic stroke: a proteomic and transcriptomic investigation
6. European Journal of Preventive Cardiology — Fatal coronary atherosclerosis in the young: rethinking systemic disease paradigms?
7. Atherosclerotic Cardiovascular Disease in Younger Populations: An Emerging Concern
8. Arterial cardiovascular disease risk after venous thromboembolism in young adults: a Danish nationwide cohort study
9. Accelerated ageing predicts earlier onset of ischaemic stroke: a proteomic and transcriptomic investigation
10. European Stroke Organisation (ESO) Guidelines on the diagnosis and management of patent foramen ovale (PFO) after stroke - Valeria Caso, Guillaume Turc, Azmil H Abdul-Rahim, Pedro Castro, Salman Hussain, Avtar Lal, Heinrich Mattle, Eleni Korompoki, Lars Søndergaard, Danilo Toni, Silke Walter, Christian Pristipino, 2024
11. May-Thurner Syndrome - StatPearls - NCBI Bookshelf