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Brain & Heart

CASE REPORT
A rare neurological association of bicuspid aortic

valve: A case report

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1
2
Rachel A. Xuereb *, John Bonello , Maria J. Bonello , Gabriel Galea , and
1
Robert G. Xuereb 1
1 Department of Cardiology, Mater Dei Hospital, Msida, Malta
2 Department of Neurology, Mater Dei Hospital, Msida, Malta
3 Department of Radiology, Mater Dei Hospital, Msida, Malta

Abstract

A 45-year-old male presented to the Emergency Department with a 2-h history
of sudden onset right-sided headache and difficulty walking. Initial non-contrast
computed tomography (CT) of the brain was unremarkable. Twelve-lead
electrocardiogram showed left ventricular (LV) hypertrophy with strain pattern. On
echocardiography, the aortic valve was noted to be bicuspid, associated with at least
moderate eccentric aortic regurgitation and moderate aortic stenosis. In view of the
initial presentation of ataxia and headaches, and the finding of bicuspid aortic valve
(BAV) on echocardiography, an urgent CT of aorta and carotid arteries was performed,
revealing dissection of the right vertebral artery and a right lateral medullary infarct.
*Corresponding author: Aortic root dilatation and aortic dissection are well known complications of BAV.
Rachel A. Xuereb However, vertebral artery dissection in the context of BAV with a normal aortic root
(rachel-anne.xuereb@gov.mt) is unusual, and to our knowledge has only been reported once in the literature so far.
Citation: Xuereb RA, Bonello J,
Bonello MJ, Galea G, Xuereb RG.
A rare neurological association of Keywords: Bicuspid aortic valve; Vertebral artery dissection; Ataxia; Aorta; Congenital
bicuspid aortic valve: A case report. heart disease
Brain & Heart. 2025;3(1):5093.
doi: 10.36922/bh.5093
Received: October 8, 2024
1st revised: November 19, 2024 1. Introduction
2nd revised: December 3, 2024 Bicuspid aortic valve (BAV) disease is the most common congenital cardiac anomaly.
1,2
Accepted: December 9, 2024 The association between BAV and aortopathy, as well as other complications such as
infective endocarditis, aortic valve stenosis, or regurgitation, is well known and reported
Published online: December 31, in the literature. Our patient presented with neurological symptoms due to dissection
3-6
2024
of the right vertebral artery in the context of a BAV disease and aortic dimensions in
Copyright: © 2024 Author(s). the upper limit of normal. The association between vertebral artery dissection and BAV
This is an Open Access article
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distributed under the terms of the has, to our knowledge, only been reported once in the literature. The current case study
Creative Commons Attribution highlights the importance of excluding BAV in patients presenting with cervicocephalic
License, permitting distribution, artery dissection and neurological complications, especially at a young age.
and reproduction in any medium,
provided the original work is
properly cited. 2. Case presentation
Publisher’s Note: AccScience A 45-year-old gentleman presented to the Emergency Department with a 2-h history
Publishing remains neutral with of sudden-onset right-sided headache and difficulty walking. He denied any chest pain,
regard to jurisdictional claims in
published maps and institutional shortness of breath on exertion, palpitations, dizziness, or syncope. He did not have
affiliations. any recent febrile illness. He was previously healthy and on no regular medications. He

Volume 3 Issue 1 (2025) 1 doi: 10.36922/bh.5093