Thinking outside the brain: a rare cause of headaches and confusion

Correspondence to Dr. Lindsey Aurora, Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA; laurora@med.umich.edu Clinical introduction A man in his 60s with a previous medical history of hypertension, diabetes mellitus and obstructive sleep apnoea presented to the emergency department with 1 month of headaches and 5 days of weakness, myalgia and altered mental status. Ao, aorta; APVR, anomalous pulmonary venous return; CS, coronary sinus; IVC, inferior vena cava; LA, left atrium; LV, left ventricle; Pa, pulmonary artery; RA, right atrium; RPA, right pulmonary artery; RV, right ventricle; LPA, left pulmonary artery. Patent foramen ovale Secundum atrial septal defect Sinus venous atrial septal defect Unroofed coronary sinus Answer: C Transesophageal echocardiogram (TEE) and cardiac CT angiogram confirmed a sinus venosus atrial septal defect (SVASD) with partial anomalous pulmonary venous return (PAPVR) and an associated persistent left SVC (PLSVC), thus C is correct.