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Stroke and Respiratory Failure: Mind the Shunt!
Diana Mano1, Patricia Campos1, Bruno Vale1
1Centro Hospitalar e Universitário do Porto, Porto, Portugal.
European Journal of Case Reports in Internal Medicine
|January 21, 2022
Summary
Stroke patients with respiratory failure may have paradoxical embolism, a rare condition involving venous and arterial clots. Platypnoea-orthodeoxia syndrome, characterized by positional breathing issues, signals potential shunts and warrants further investigation.
Area of Science:
- Neurology
- Cardiology
- Pulmonology
Background:
- Stroke patients with respiratory failure are often presumed to have aspiration pneumonia.
- Other potential causes, including paradoxical embolism, should be considered.
Purpose of the Study:
- To highlight paradoxical embolism as a cause of stroke and respiratory failure.
- To emphasize the significance of platypnoea-orthodeoxia syndrome in identifying shunts.
Main Methods:
- Case report of a patient with ischemic stroke and subsequent platypnoea-orthodeoxia syndrome.
- Diagnostic workup including imaging to identify pulmonary embolism and arteriovenous malformations.
Main Results:
- The patient presented with ischemic stroke and developed platypnoea-orthodeoxia syndrome.
- Simultaneous pulmonary embolism and pulmonary arteriovenous malformations were documented, indicating paradoxical embolism.
Conclusions:
- Paradoxical embolism, involving both arterial and venous thrombosis, can present with stroke and respiratory failure.
- Platypnoea-orthodeoxia syndrome is a key indicator for intracardiac or intrapulmonary shunts.
- Clinicians should consider paradoxical embolism and investigate for shunts in relevant cases.
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