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A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
06:01

A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia

Published on: August 18, 2015

Thrombus-in-transit causing paradoxical embolism in cerebral and coronary arterial circulation

Muriel Delvigne1, Paul Vermeersch, Paul van den Heuvel

  • 1Department of Cardiology, General Hospital AZ Middelheim, Antwerp, Belgium. murieldelvigne@yahoo.com

Acta Cardiologica
|January 8, 2005
PubMed

Insights

This case study highlights paradoxical embolism, a rare condition where a clot travels from the venous system to the arterial system via a patent foramen ovale, causing stroke and heart attack.

Area of Science:

  • Cardiology
  • Neurology
  • Vascular Medicine

Background:

  • Paradoxical embolism is a rare but serious condition where venous thrombi cross to the arterial circulation.
  • A patent foramen ovale (PFO) is a common cardiac anomaly that can facilitate paradoxical embolism.
  • Simultaneous myocardial infarction and ischemic stroke present a diagnostic challenge.

Observation:

  • An elderly male patient presented with acute anterior myocardial infarction and acute bioccipital ischemic stroke.
  • Coronary angiography showed embolization in the left anterior descending artery and a septal branch.
  • Transesophageal echocardiography revealed a large, mobile thrombus crossing a patent foramen ovale.

Findings:

  • The diagnosis of paradoxical embolism was confirmed by transesophageal echocardiography.
  • Deep venous thrombosis was identified as the likely source of the intra-atrial thrombus.
  • Pulmonary embolism was also present, contributing to elevated right heart pressure.

Implications:

  • This case underscores the importance of considering paradoxical embolism in patients with cryptogenic stroke and myocardial infarction.
  • Early diagnosis and anticoagulation are crucial for managing paradoxical embolism.
  • Transcatheter PFO closure can be a viable option after thrombus resolution.

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