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Paradoxical embolism in a boy with cystic fibrosis and a stroke
1Department of Paediatrics, Neonatal Intensive Care Unit, Queen's Medical Centre, Nottingham NG7 2UH, UK.
Insights
A stroke in a cystic fibrosis patient was caused by a blood clot from a venous access device traveling through a heart defect. Closing the heart defect resolved the stroke symptoms, marking the first reported paradoxical embolism linked to such devices.
Area of Science:
- Cardiology
- Neurology
- Pediatrics
Background:
- Cystic fibrosis (CF) patients face increased risks for thromboembolic events.
- Totally implantable venous access devices (Port-a-Cath) are common in CF patients for treatment delivery.
- Paradoxical embolism, where a clot travels from venous to arterial circulation, is a rare but serious complication.
Observation:
- An 11-year-old boy with CF experienced a stroke (right-sided weakness) secondary to a Port-a-Cath insertion four years prior.
- Magnetic resonance angiography revealed a left middle cerebral artery filling defect.
- Transesophageal echocardiography identified a thrombus on the Port-a-Cath tip and a patent foramen ovale.
Findings:
- The patient underwent anticoagulation followed by transcatheter closure of the patent foramen ovale using a septal occlusion device.
- Neurological deficits completely resolved post-intervention.
- No further thromboembolic events occurred during follow-up.
Implications:
- This case highlights a novel mechanism of stroke in a pediatric CF patient, involving a Port-a-Cath-associated thrombus and patent foramen ovale.
- It underscores the importance of considering paradoxical embolism in young patients with venous access devices and unexplained neurological events.
- Transcatheter closure of a patent foramen ovale can be an effective treatment to prevent recurrent paradoxical emboli.
Abstract:
An 11 year old boy with cystic fibrosis suffered a stroke, producing right sided weakness. Four years previously a totally implantable venous access device (Port-a-Cath) had been inserted. Magnetic resonance angiography revealed a filling defect in the left middle cerebral artery. Transoesophageal echocardiography demonstrated a thrombus attached to the tip of the Port-a-Cath and also the presence of a patent foramen ovale. After an initial period of anticoagulation the defect was closed using a septal occlusion device introduced via a cardiac catheter. The boy's neurological signs completely resolved and he remains free from further thromboembolic episodes. Whilst pulmonary embolism has been described before in relation to a totally implantable venous access device, this is believed to be the first description of a paradoxical embolism in relation to such a device.