We present a 47-year-old patient presenting with lower extremity ischemia secondary to paradoxical embolism. This case highlights the importance of evaluating for paradoxical embolism in otherwise-unexplained cases of acute limb ischemia. [ncbi.nlm.nih.gov]

• Lower Extremity Pain

  A 58-year-old male presented with severe substernal chest pain along with bilateral lower extremity pain. He was tachycardic, tachypneic, and hypoxic with tender right calf. Electrocardiogram showed ST elevation in anterior-lateral leads. [ncbi.nlm.nih.gov]

• Decreased Breath Sounds

  Noncategorized findings included coma, decreased breath sounds, bilateral pleural effusions, edema, acute myocardial infarction, and arrhythmias. [jamanetwork.com]

• Hepatomegaly

  Abdominal examination findings revealed massive hepatomegaly and ascites. Although there was bilateral edema of her lower extremities, findings from the remainder of her physical examination were unremarkable. [jamanetwork.com]

• Anisocoria

  Increased neurological distress was suggested by anisocoria with areactive left mydriasis and body‑part pyramidal syndrome. A cerebral CT scan showed left sylvian and cerebellar infarctions. [docksci.com]

• Stupor

  The symptoms included motor deficit in eight patients (50%), aphasia in one patient (6%), visual disturbances in four patients (25%), headache in four patients (25%), stupor in one patient (6%), and dysarthria in three patients (18%) ( Table 3 ). [synapse.koreamed.org]

• Expressive Aphasia

  Neurological examination revealed expressive aphasia, right hemianopsia, right central facial paralysis and right-sided paresis with a National institute of Health Stroke Scale of 19. [ncbi.nlm.nih.gov]

• Dysmetria

  On awakening, after 48 h of endotracheal intubation, she displayed dysarthria and dysmetria. Her brain CT scan showed no haemorrhagic lesions. A chest CT scan ruled out a potential pulmonary embolism. [ncbi.nlm.nih.gov]

Further workup revealed the presence of a PFO with a large right-to-left shunt. After being put on antithrombotic therapy, she presented again at 13 gestational weeks with a new ischemic infarction in the vertebrobasilar territory. [ncbi.nlm.nih.gov]

Cardiac Workup of Ischemic Stroke. Cur. Cardiol. Rev. 6(3), 175-183 (2010). Yaghi S, Elkind MSV. Cryptogenic stroke: A diagnostic challenge. Neurology: Clin. Prac. 4(5), 386-393 (2014). Lechat P, Mas JL, Lascault G, et al. [openaccessjournals.com]

However, at that time, the workup did not include thrombophilia screen or contrast echocardiogram. She made a good functional recovery from the stroke with minimal residual neurological deficit. [jpgmonline.com]

• Mural Thrombus

  Complete etiologic work-up led to the discovery of both a patent foramen ovale associated with an septum interauricular aneurysm, and of a PVA without mural thrombus. The diagnosis of brain paradoxical embolism was retained. [ncbi.nlm.nih.gov]

• Thrombocytosis

  Bilateral coronary thrombosis in the absence of inducible coronary spasm, thrombocytosis, coagulation abnormalities, or angiographic evidence of coronary artery disease: Previously undescribed method of myocardial infarction. [jstage.jst.go.jp]

• Electrical Alternans

  The chest radiograph revealed mild elevation of the right hemidiaphragm and bibasilar atelectasis, and the electrocardiogram revealed sinus tachycardia with low voltage but no electrical alternans, ischemia, P pulmonale, S 1 Q 3 T 3 pattern, or right [jamanetwork.com]

Treatment choices consist of anticoagulation, thrombectomy, or thrombolysis. Choice of treatment is difficult but should be made quickly to reduce the possibility of adverse patient outcomes. [ncbi.nlm.nih.gov]

Therapeutic options include surgical treatment with thrombectomy or medical treatment with heparin or thrombolysis. [em-consulte.com]

This approach is also used in the treatment of a present embolism, albeit at higher doses. [en.wikipedia.org]

The appearance of the thrombi has been associated with short-term prognosis. ( 5 ) Not only is early mortality (< 8 days) higher for patients with type A than for those with type C or B (42%, 14%, and 4%, respectively), but also the risk of pulmonary [scielo.br]

CT may only be diagnostic in the acute setting as gas is absorbed rapidly 4 use of lung windows may help increase detection Treatment and prognosis Treatment is typically supportive although there is increasing evidence for the use of hyperbaric oxygen [radiopaedia.org]

Abstract Patent foramen ovale (PFO) is more common in patients with stroke than in matched controls, but the stroke mechanism and late prognosis are not well known. [neurology.org]

Prognosis PDE generally has a good prognosis when it is not complicated. Morbidity and mortality are increased in patients with PDE and PE, depending on the size of the embolus and end-organ lodgment. [emedicine.medscape.com]

The diagnosis of paradoxical embolism with intraoperative identification of the etiologic site of the deep venous thrombosis is a rare event. [ncbi.nlm.nih.gov]

Article Fr | MEDLINE | ID: mdl-29096902 Embolism, Paradoxical/diagnosis, Embolism, Paradoxical/etiology, Foramen Ovale, Patent/complications, Foramen Ovale, Patent/diagnostic imaging, Heart Septal Defects, Atrial/complications, Heart Septal Defects, Atrial [pesquisa.bvsalud.org]

France/epidemiology, Humans, Incidence [pesquisa.bvsalud.org]

We review the epidemiology, pathophysiology, and management of pulmonary AVMs in relation to stroke risk. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved. [ncbi.nlm.nih.gov]

Strokes in young adults: epidemiology and prevention. Vascul. Heal. Risk. Manag. 11, 157-164 (2015). Windecker S, Stortecky S, Meier B. Paradoxical Embolism. J. Am. Coll. Cardiol. 64(4), 403-415 (2014). [openaccessjournals.com]

[…] and genitourinary surgical procedures Trauma Intracardiac communication of the venous and arterial circulations can lead to PDE and may occur via the following: PFO ASD Pulmonary arteriovenous malformation VSD Ebstein anomaly Patent ductus arteriosus Epidemiology [emedicine.medscape.com]

Patent foramen ovale: current pathology, pathophysiology, and clinical status. J Am Coll Cardiol 2005; 46:1768 DOI: 10.1016/j.jacc.2005.08.038; Loscalzo J. [icfjournal.org]

We review the epidemiology, pathophysiology, and management of pulmonary AVMs in relation to stroke risk. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved. [ncbi.nlm.nih.gov]

Paradoxical embolisms represent two percent of arterial emboli. [2] Pathophysiology [ edit ] Passage of a clot (thrombus) from a systemic vein to a systemic artery. [en.wikipedia.org]

Thus it is not surprising that we also found a subset of patients with MI caused by this pathophysiology. [jstage.jst.go.jp]

Therapeutic Options to Prevent Stroke or TIA in PFO Patients Primary Prevention Prevention strategies for a first-time stroke do not differ in patients with respect to PFO status. [circ.ahajournals.org]

On the basis of data from 3 recently published, randomized, clinical trials involving stroke prevention in PFO patients, a medical therapeutic strategy was favored over percutaneous PFO closure to prevent recurrent paradoxical embolism. [dx.doi.org]

Although anticoagulation is necessary to prevent paradoxical emboli, the hematologic disturbances and the most appropriate therapy in these patients warrant further investigation. Copyright © 2016 Elsevier Inc. All rights reserved. [ncbi.nlm.nih.gov]