Stroke resulting from an isolated pulmonary arteriovenous malformation

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Neurology

Background:

• Isolated pulmonary arteriovenous malformations (PAVM) are uncommon vascular anomalies.
• PAVM can lead to paradoxical embolic events, including stroke.
• Prompt recognition and intervention are key for optimal patient outcomes.

Observation:

• A 45-year-old woman presented with stroke symptoms (left-sided weakness, slurred speech).
• Initial work-up was inconclusive; cryptogenic stroke was diagnosed.
• Transoesophageal echocardiogram suggested an atrial septal defect, but it was not clearly visualized.

Findings:

• Pulmonary angiography identified an isolated PAVM in the right lower lung.
• The PAVM had a 2mm feeding artery and dysplastic vessels connecting to a vein.
• Successful embolisation was achieved using an Amplatzer Vascular Plug and a Nester coil.

Implications:

• This case highlights the importance of considering PAVM in patients with cryptogenic stroke, especially with atypical symptoms.
• Early diagnosis through advanced imaging like pulmonary angiography is critical.
• Endovascular embolisation is an effective treatment for PAVM, preventing further embolic complications.