Problems in identifying paradoxical cerebral embolism: Case report with discussion

Area of Science:

• Cardiology
• Neurology
• Oncology

Background:

• Rectal cancer is a significant health concern.
• Cerebral embolism can lead to severe neurological deficits.
• Paradoxical embolism, often linked to cardiac shunts, presents diagnostic challenges.

Purpose of the Study:

• To report a rare case of paradoxical cerebral embolism in a patient with newly diagnosed rectal cancer.
• To highlight the diagnostic difficulties associated with paradoxical embolism.
• To discuss the implications of patent foramen ovale in embolic events.

Main Methods:

• Case report of a 63-year-old male with rectal cancer.
• Clinical presentation including pulmonary embolism, deep venous thrombosis, and bilateral cerebral infarction.
• Diagnostic workup including echocardiography and autopsy findings.

Main Results:

• The patient presented with simultaneous pulmonary embolism and left hemiplegia, suggestive of paradoxical embolism.
• Despite vena caval filter placement, a second cerebral infarction occurred.
• Autopsy confirmed a patent foramen ovale as the likely source of embolism.

Conclusions:

• Patent foramen ovale can facilitate paradoxical embolism in cancer patients.
• Early identification and management of venous thromboembolism are critical.
• This case underscores the importance of considering paradoxical embolism in patients with unexplained embolic events and risk factors.