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Paradoxical brain embolism shadowing massive pulmonary embolism
Patent foramen ovale is frequently observed in the general population. In case of massive pulmonary embolism, the sudden increase in the right heart cavity's pressure may cause a right-to-left shunting across this foramen, which could be associated with conflicting outcomes. Herein, we report a case of reversible cardiac arrest preceded by seizures, and followed by hemodynamic stability without any vasopressor. A brain CT-scan showed a limited ischemic stroke. Initial echocardiographic assessment revealed an acute cor pulmonale and a right-to-left intracardiac shunt across a large patent foramen ovale, suggesting the diagn...
Source: The American Journal of Emergency Medicine - May 15, 2018 Category: Emergency Medicine Authors: Fran çois Bagate, Alexandre Bedet, Armand Mekontso Dessap, Guillaume Carteaux Source Type: research

Acute Ischemic Stroke in a Young Woman With No Known Risk Factors.
CONCLUSION: Onset of neurologic symptoms can be immediate or delayed in patients undergoing venous foam sclerotherapy. Early recognition of neurologic deficits resulting from paradoxical gas embolism and its treatment with hyperbaric oxygen can prevent permanent disability. PMID: 29677415 [PubMed - in process]
Source: WMJ - March 1, 2018 Category: General Medicine Authors: Abdelhamid N, Farooq S, Sarraj A Tags: WMJ Source Type: research

Angiography vs transesophageal echocardiography ‐guided patent foramen ovale closure: A propensity score matched analysis of a two‐center registry
ConclusionsThe use of intra‐procedural transesophageal echocardiography (TEE) guidance for PFO closure allows lower residual shunt rate, radiological exposure, and adverse events, mainly driven by a significant reduction in percutaneous reintervention.
Source: Echocardiography - February 19, 2018 Category: Cardiology Authors: Paolo Scacciatella, Ilaria Meynet, Mauro Giorgi, Lorenza M. Biava, Ivana Matranga, Luigi Biasco, Pierluigi Omed è, Fulvio Orzan, Fiorenzo Gaita Tags: ORIGINAL INVESTIGATION Source Type: research

Pulmonary Embolism in Ischemic Stroke.
Abstract Silent pulmonary embolism (PE) may be associated with acute ischemic stroke (AIS). We identified 10 patients from 3,132 unique patients (3,431 CT scans). We retrospectively examined CT angiogram of patients with AIS to determine the frequency of concurrent PE in AIS. The period prevalence of PE was 0.32. Seven patients had concurrent PE, whereas three had PE diagnosed 2 days after their AIS presentation. We suspected paradoxical embolism via patent foramen ovale as the cause of stroke in three patients and thrombophilia in four patients. Seven patients had poor outcome including four deaths. CT angiogram ...
Source: The Canadian Journal of Neurological Sciences - January 28, 2018 Category: Neurology Authors: Eswaradass PV, Dey S, Singh D, Hill MD Tags: Can J Neurol Sci Source Type: research

Recurrent Patent Foramen Ovale-Related Cerebral Infarcts Alternately Causing Bilateral Hand Paresis
Isolated hand paresis is a rare presentation of stroke, which mostly results from a lesion in the cortical hand motor area, a knob-like area within the precentral gyrus. I report the case of a patient who experienced recurrent ischemic stroke alternately involving bilateral hand knob areas, causing isolated hand paresis. There was no abnormal finding on brain and neck magnetic resonance angiography, transthoracic echocardiography, and 48-h Holter monitoring, and there were no abnormal immunologic and coagulation laboratory findings. The only embolic source was found to be a patent foramen ovale, which was proven on transes...
Source: Case Reports in Neurology - October 25, 2017 Category: Neurology Source Type: research

Advanced imaging in acute ischemic stroke.
Abstract The evaluation and management of acute ischemic stroke has primarily relied on the use of conventional CT and MRI techniques as well as lumen imaging sequences such as CT angiography (CTA) and MR angiography (MRA). Several newer or less-established imaging modalities, including vessel wall MRI, transcranial Doppler ultrasonography, and 4D CTA and MRA, are being developed to complement conventional CT and MRI techniques. Vessel wall MRI provides high-resolution analysis of both extracranial and intracranial vasculature to help identify previously occult lesions or characteristics of lesions that may porten...
Source: Neurosurgical Focus - April 1, 2017 Category: Neurosurgery Authors: Kilburg C, Scott McNally J, de Havenon A, Taussky P, Kalani MY, Park MS Tags: Neurosurg Focus Source Type: research

Decompressive craniectomy for malignant middle cerebral artery infarction in a 16-year old boy: a case report
ConclusionsThis case highlights the preponderance of cryptogenic stroke in younger patients and its etiological elusiveness. It further demonstrates that age is predictive in terms of survival and functional outcome in the context of malignant middle cerebral artery infarction.
Source: Journal of Medical Case Reports - December 19, 2016 Category: Journals (General) Source Type: research

Diagnostic and Management Challenges in Patients with Left Atrial Myxoma (P1.229)
Conclusions:Cardiac myxomas are rare tumors, mostly arising from the left atrium that may cause ischemic or hemorrhagic strokes, intracranial aneurysms, or myxomatous metastases.Disclosure: Dr. Orjuela has nothing to disclose. Dr. McGinley has nothing to disclose. Dr. Sweis has nothing to disclose. Dr. Prabhu has nothing to disclose. Dr. Bakhos has nothing to disclose. Dr. Biller has received personal compensation in an editorial capacity for the Journal of Stroke and Cerebrovascular Diseases, Frontier in Neurology and Up-To-Date.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Orjuela, K., McGinley, M., Sweis, R., Prabhu, V., Bakhos, M., Biller, J. Tags: Cardiac Mechanisms and Complications of Stroke Source Type: research

A Case of Multiple Recurrent Ischemic Stroke in a Patient with Cholangiocarcinoma and Initiation of Anticoagulation Therapy for Secondary Stroke Prevention (P4.342)
CONCLUSIONS: Initiation of anticoagulation therapy and the optimal medications for secondary stroke prevention in cancer associated stroke remain controversial. Further randomized prospective studies are needed to establish treatment guidelines.Disclosure: Dr. Cheng has nothing to disclose. Dr. Then has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Cheng, J. Z., Then, R. Tags: Cerebrovascular Case Reports Source Type: research

Stroke Due to Air Embolism Related to Laser Ablation of Accessory Vein (P4.357)
Conclusions: Air embolism leading to devastating stroke may occur few hours after laser treatment of varicose veins. Chest symptoms associated with the procedure should raise the possibility of air embolism. Immediate therapeutic measures like 100[percnt] oxygen, hyperbaric oxygen chamber and/or hypothermia should be considered to prevent neurologic complications.Disclosure: Dr. Kale has nothing to disclose. Dr. Javed has nothing to disclose. Dr. Pednekar has nothing to disclose. Dr. Sahni has nothing to disclose. Dr. Resor has nothing to disclose. Dr. Tenner has nothing to disclose. Dr. Ahluwalia-Singh has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Kale, P., Javed, B., Pednekar, N., Sahni, R., Resor, L., Tenner, M., Ahluwalia-Singh, B. Tags: Cerebrovascular Case Reports Source Type: research

Diagnostic Yield of Venous Thrombosis and Pulmonary Embolism by Combined CT Venography and Pulmonary Angiography in Patients with Cryptogenic Stroke and Patent Foramen Ovale
Background: Paradoxical embolism via a patent foramen ovale (PFO) has been suggested as a potential stroke mechanism. Combined CT venography and pulmonary angiography (CVPA) is a simple, validated and accurate technique to diagnose deep venous thrombosis (DVT) or pulmonary embolism (PE). We sought to assess the prevalence of DVT or PE among patients with PFO and cryptogenic stroke (CS) by CVPA. Methods: Patients were identified retrospectively from a clinical registry of consecutive patients with stroke admitted to our Stroke Unit. The following criteria were required for inclusion in this study: CS, PFO identified by tran...
Source: European Neurology - July 25, 2015 Category: Neurology Source Type: research

Clot Through the Heart: Paradoxical Embolism With Thrombus-in-Transit at Multidetector Computed Tomography
We present the case of a 67-year-old man with concomitant stroke and pulmonary embolism 1 day after radiofrequency catheter ablation for refractory atrial tachycardia. A chest computed tomographic angiogram revealed “thrombus-in-transit” across a patent foramen ovale, confirming the diagnosis of paradoxical embolism. Paradoxical embolism is a rare definitive diagnosis. Our case is a key demonstration of the even rarer instance where such a diagnosis is confirmed at multidetector computed tomography.
Source: Journal of Computer Assisted Tomography - July 1, 2015 Category: Radiology Tags: Cardiothoracic Imaging Source Type: research

Ischemic stroke after pellet embolization
A 9-year-old boy was shot with a pellet shotgun and developed a visual field deficit. Head CT revealed a pellet in the left ambien cistern, in the left posterior cerebral artery on catheter angiography (figure). Chest fluoroscopy revealed multiple thoracic pellets, including a mobile cardiac pellet (video on the Neurology® Web site at Neurology.org). There was no clear cardiac injury, patent foramen ovale, or skull penetration. Arterial embolization of a pellet from the chest to the intracranial vasculature likely caused a stroke.1,2 We considered arteriotomy, endovascular retrieval, and medical therapy. The establishe...
Source: Neurology - June 8, 2015 Category: Neurology Authors: Aghaebrahim, A., Giurgiutiu, D.-V., Jankowitz, B. T., Jovin, T., Jadhav, A. P. Tags: All Cerebrovascular disease/Stroke, Embolism VIDEO NEUROIMAGES Source Type: research

Value of Eye Movement Exam in Aiding Precise Localization in Stroke (P1.016)
We present an unusual presentation of midbrain stroke presenting with bilateral ptosis in an African American male with vascular risk factors and concurrent use of bevacizumab. This case illustrates how detailed knowledge of anatomy and detailed neurologic exam remain valuable tools for localizing and diagnosing subtle presentations of common neurologic disease. Case description: A 69 year-old African American man with vascular risk factors including hypertension, hyperlipidemia and poorly controlled diabetes experienced sudden onset horizontal diplopia associated with fatigue. The patient presented to the Emergency Depart...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Khandker, N., Schmerler, D., Mahajan, S., Serra, A., Strbian, D. Tags: Cerebrovascular Disease and Interventional Neurology I ePosters Source Type: research

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