Ischemic stroke in a patient with Crohn's disease: a confirmed paradoxical embolism mechanism

Lange, Marcos Christiano; Zamproni, Laura N.; Braatz, Vera; Fernandes, Artur Furlaneto; Zétola, Viviane Flumignan; Nóvak, Edison Matos

doi:10.1590/s0004-282x2010000400033

Cited by 5 publications

(4 citation statements)

References 8 publications

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“…No relationship was found between multiple ischemic events and cortical stroke and the presence of an RLS. Interestingly, a high prevalence of RLS was found in both groups with APS (65 and 53%) versus the population prevalence estimated in the literature (30%) 12 . Unfortunately, there is no data in the literature comparing the prevalence of RLS in the APS population versus healthy subjects.…”

Section: Discussioncontrasting

confidence: 53%

“…Systemic hypercoagulable states can potentially increase clot formation 12 . It is reasonable to hypothesize that patients with hypercoagulable states may be at a higher risk of developing a paradoxical embolism and stroke.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, there is no literature to prove this association 13,14 . Most of the published data on this issue are either anecdotal or case series 12 . Di Tullio et al 15 reported a significantly higher prevalence of protein C deficiency in 25 stroke patients with PFO compared with 195 without PFO.…”

Section: Discussionmentioning

confidence: 99%

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Right-to-left shunt and the hypercoagulable state: does paradoxical embolism play a role in patients with antiphospholipid syndrome and stroke?

Zamproni

Zétola

Lange

2012

Arq. Neuro-Psiquiatr.

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Patients with cryptogenic arterial ischemic stroke have a high prevalence of a patent foramen ovale (PFO) 1 . However, the simple existence of a right-to-left shunt (RLS) does not appear sufficient to explain the increased risk of ischemic stroke, and other significant factors must be required 2 . A hypercoagulable state could be one of these factors, because it increases thrombogenic mechanisms, such as venous thrombosis, which is related to paradoxical embolism (PE) 3 . Antiphospholipid syndrome (APS) is one of the most frequently acquired thrombophilias 4 . The presence of antiphospholipid antibodies (aPL) is associated with ischemic stroke [4][5][6][7] . Nevertheless, the mechanism underlying stroke in these patients remains unclear, and there is a lack of data in the literature on the role that PE may play in the pathophysiology of arterial ischemic stroke in APS patients. Therefore, the association of stroke with the combined presence of APS and an RLS is of interest.The aim of this study was to verify whether APS patients who have experienced stroke present with a higher frequency of RLS than patients with APS without a history of stroke. ABSTRACTObjective: Patent foramen ovale is associated with paradoxical embolism (PE) and stroke. Hypercoagulable states, such as antiphospholipid syndrome (APS), can exacerbate PE by increasing clot formation. The aim of this study was to verify whether patients with APS and stroke present a right-to-left shunt (RLS) with greater frequency than patients with APS but without stroke. Methods: Fifty-three patients with APS were tested for RLS using contrast-enhanced transcranial Doppler (cTCD): 23 patients had a history of stroke (Stroke Group) and 30 had no history of stroke (No-stroke Group). Results: cTCD was positive in 15 patients (65%) from the Stroke Group and in 16 patients (53%) in the No-stroke Group (p=0.56). The proportion of patients with a small RLS (≤10 high-intensity transient sign or HITS) and a large RLS (>10 HITS) was similar between the groups without significant difference. Conclusions: Our data do not support the theory that paradoxical embolism may play an important role in stroke in APS patients.Key words: antiphospholipid syndrome, stroke, paradoxical embolism, right-to-left shunt. RESUMOObjetivo: O forame oval patente está associado com embolia paradoxal e acidente vascular cerebral isquêmico (AVCi). Estados de hipercoagulabilidade, como a síndrome antifosfolipídica (SAF), podem facilitar esse processo, aumentando a formação de coágulos. O objetivo deste estudo foi verificar se pacientes com SAF e AVCi apresentam maior frequência de shunt direita-esquerda (SDE), comparados a pacientes com SAF sem AVCi. Métodos: Cinquenta e três pacientes com SAF foram testados para SDE usando Doppler transcraniano contrastado (DTCc): 23 com AVCi (Grupo AVC) e 30 sem história de AVCi (Grupo Controle). Resultados: DTCc foi positivo em 15 pacientes (65%) do Grupo AVC e em 16 pacientes (53%) no Grupo Controle (p=0,56). A proporção de pacientes com pequeno SDE (≤10 HIT...

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

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Right-to-left shunt and the hypercoagulable state: does paradoxical embolism play a role in patients with antiphospholipid syndrome and stroke?

Zamproni

Zétola

Lange

2012

Arq. Neuro-Psiquiatr.

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“…El tratamiento de elección del FOP todavía no está definido. Así, se recomienda no dar tratamiento alguno en los casos asintomáticos y agregar antiplaquetarios o anticoagulantes en caso de trombos en cavidades cardiacas, fenómenos trombofílicos asociados o episodios previos de derrame cerebral (5,(10)(11)(12) .…”

Section: Discussionunclassified

Embolismo paradojal - tromboembolismo pulmonar e isquemia cerebral por foramen oval permeable: reporte de caso

Pérez¹,

Gamero²

2016

An Fac med

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ResumenEl 30 a 40% de las enfermedades cerebrovasculares presentan un origen desconocido o criptogénico. Puede estar relacionado con la persistencia de foramen oval (FOP), cuya prevalencia es de 12 a 30%. Reportamos el caso de una paciente mujer de 62 años, que fue intervenida por tumoración de tiroides. En el postoperatorio presentó disnea, hipoxemia, compromiso de conciencia y afasia de expresión. La ecocardiografía transtorácica mostró dilatación de cámaras derechas y la ecocardiografía transesofágica reveló un foramen oval permeable (FOP) con la presencia de ecos compatibles con coágulos que bordeaban dicho orificio: la tomografía cerebral evidenció un infarto cerebral en el hemisferio izquierdo. El hallazgo de coágulos y del FOP en el intraoperatorio confirmó el desarrollo de tromboembolismo pulmonar y embolismo paradojal. Palabras clave. Embolismo Paradojal; Isquemia Cerebral; Foramen Oval. Abstract 30 to 40% of cerebrovascular diseases are of unknown or cryptogenic origin; they may be related to patent foramen ovale (PFO) with a prevalence of 12 to 30%. We report the case of a 62 year old woman who underwent surgery for a thyroid tumor. In the postoperative period she presented dyspnea, hypoxemia, impaired consciousness and expression aphasia. Transthoracic echocardiography showed dilatation of right chambers, and transesophageal echocardiography revealed a patent foramen ovale (PFO) with the presence of echoes compatible with clots bordering this defect; the brain scan revealed a stroke in the left hemisphere. The presence of clots and PFO intraoperatively confirmed the development of pulmonary embolism and paradoxical embolism. INTRODUCCIÓNLa enfermedad cerebrovascular (ECV) es la tercera causa de muerte y la primera causa de invalidez en el mundo. Aproximadamente 25% de los varones y 20% de las mujeres sufrirán una ECV si viven hasta los 85 años o más (1) . También presenta alta probabilidad de recurrencia, por lo cual el diagnóstico etiológico es la base para la prevención secundaria. Pero, algunos estudios llegan a reportar un 30% a 40% de ECV de causa desconocida o criptogénica, o también llamados stroke criptogénicos (SC) que se presentan principalmente en menores de 55 años, en los que el FO permeable es un hallazgo relativamente común y que se relacionan con embolismo paradojal (EP) (2)(3)(4) . El embolismo conlleva a stroke o ataque isquémico (derrame cerebral) que puede originarse en el sistema venoso (embolismo paradojal) o en la circulación arterial sistémica (2)(3)(4)(5) .El foramen oval persistente (FOP) y el aneurisma septal auricular están asociados a derrame cerebral criptogé-nico, sugiriendo asociación al embolismo paradojal; sin embargo, no existe relación lineal de causa-efecto. De hecho, la presencia de un defecto como el FOP no constituye una relación lineal como factor de riesgo independiente de derrame cerebral isquémico (1,2,5,6) . El derrame cerebral cripotogénico es determinado clínicamente y por neuroimagen; se debe plantear estudios de

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Increased risk of stroke among patients with ulcerative colitis: a population-based matched cohort study

Keller

Wang

Huang

et al. 2014

Int J Colorectal Dis

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Ischemic stroke in a patient with Crohn's disease: a confirmed paradoxical embolism mechanism

Cited by 5 publications

References 8 publications

Right-to-left shunt and the hypercoagulable state: does paradoxical embolism play a role in patients with antiphospholipid syndrome and stroke?

Right-to-left shunt and the hypercoagulable state: does paradoxical embolism play a role in patients with antiphospholipid syndrome and stroke?

Embolismo paradojal - tromboembolismo pulmonar e isquemia cerebral por foramen oval permeable: reporte de caso

Increased risk of stroke among patients with ulcerative colitis: a population-based matched cohort study

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