Investigation of patent foramen ovale as a mechanism for brain metastasis in patients without prior lung involvement

Levin-Epstein, Rebecca; Kumar, Preetham; Rusheen, Joshua; Fleming, Rubine Gevorgyan; McWatters, Zoe; Kim, Won; Kaprealian, Tania; West, Brian; Tobis, Jonathan M.

doi:10.1007/s12094-020-02471-y

Cited by 3 publications

(4 citation statements)

References 32 publications

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“…Rigatelli et al hypothesized that circulating tumor cells reach the brain circulation via two concurrent pathways: First, circulating tumor cells pass the pulmonary filter and reach systemic circulation via pulmonary capillaries; second, they enter systemic circulation via a right to left shunt 20 . However, in a small prospective pilot study by Levin‐Epstein et al including nine cancer patients (thyroid‐, breast‐ and upper intestinal carcinoma), was demonstrated a similar prevalence of PFO in patients who developed brain metastases without preceding pulmonal metastasis compared to estimates for the general population 21 . Further larger studies are needed to reveal if a PFO increases both, the risk of thromboembolic and malignant arterial paradoxical embolism in cancer patients and may therefore be taken into consideration to be closed preventive.…”

Section: Discussionmentioning

confidence: 88%

“…20 However, in a small prospective pilot study by Levin‐Epstein et al including nine cancer patients (thyroid‐, breast‐ and upper intestinal carcinoma), was demonstrated a similar prevalence of PFO in patients who developed brain metastases without preceding pulmonal metastasis compared to estimates for the general population. 21 Further larger studies are needed to reveal if a PFO increases both, the risk of thromboembolic and malignant arterial paradoxical embolism in cancer patients and may therefore be taken into consideration to be closed preventive.…”

Section: Discussionmentioning

confidence: 99%

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Cardiac metastasis causes paradoxical malignant embolism

Wagner

Hobbach

et al. 2021

Cancer Reports

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Background: Embolic events play an important role in clinical everyday practice.Malignant arterial embolism is a rare nevertheless often fatal entity for cardiac, cerebral or systemic ischemia, requiring immediate diagnosis and treatment.Case: This is a case report of a 65 years-old female, suffering from pulmonal adenocarcinoma, who was hospitalized due to neurological deficits caused by an acute ischemic stroke, followed by anterior myocardial infarction within 3 days. Diagnostic work-up revealed metastasis of the pulmonal adenocarcinoma in the right atrium and a patent foramen ovale. Histopathological examination of the coronary embolus verified paradoxical arterial embolism of the pulmonal adenocarcinoma into a coronary vessel and consequently cerebral arteries. Conclusion:The present case underlines the need for (i), consideration of malignant embolism, (ii) histopathological examination of the embolus to determine its etiology, and (iii) interdisciplinary discussion of individual therapeutic and prevention strategies in cancer patients with cerebral, cardiac or systemic embolic events.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Cardiac metastasis causes paradoxical malignant embolism

Wagner

Hobbach

et al. 2021

Cancer Reports

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“…4 PFO can also cause dysfunction of cerebral vascular endothelial cells, changes in cortical excitability or trigger cortical spreading depression (CSD) by inducing ischemia/hypoxia, which predisposes patients to conditions such as stroke, migraine, and obstructive sleep apnea. [4][5][6][7] Epilepsy is often comorbid with migraine, and they overlap in many clinical features, treatment options, and common pathogenic mechanisms, such as hypoxia, CSD, and micro-emboli. 8,9 In fact, we had previously found an association between RLS and oxygen desaturation in people with epilepsy (PWE).…”

Section: Introductionmentioning

confidence: 99%

“…PFO can open widely under certain hemodynamic conditions, allowing for the passage of unoxygenated venous blood and micro‐emboli from the venous to the arterial circulation, potentially leading to a hypoxemic event 4 . PFO can also cause dysfunction of cerebral vascular endothelial cells, changes in cortical excitability or trigger cortical spreading depression (CSD) by inducing ischemia/hypoxia, which predisposes patients to conditions such as stroke, migraine, and obstructive sleep apnea 4–7 . Epilepsy is often comorbid with migraine, and they overlap in many clinical features, treatment options, and common pathogenic mechanisms, such as hypoxia, CSD, and micro‐emboli 8,9 .…”

Section: Introductionmentioning

confidence: 99%

Association of patent foramen ovale with epilepsy: A hospital‐based case–control study

Tang

et al. 2023

Epilepsia Open

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ObjectiveThis study aimed to investigate the proportion of patent foramen ovale (PFO) in people with epilepsy (PWE) compared to controls without epilepsy and to assess whether PWEs with and without PFO exhibit distinctive clinical features.MethodsThis is a case–control study conducted in a hospital. Contrast transthoracic echocardiography with a venous microbubble bolus and provocative maneuvers (Valsalva and coughing) were used to identify PFO and its right‐to‐left shunt (RLS) among 741 PWEs and 800 controls without epilepsy. The risk of having PFO in PWEs was explored using multiple matching methods and logistic regression with adjusted congenital factors that may affect the occurrence of PFO.ResultsThe proportion of PFO in PWEs and controls was 39.00% and 24.25%, respectively. After 1:1 propensity score matching, the risk of suffering PFO in PWEs was 1.71 times (OR, 1.71; 95% CI, 1.24–2.36) higher than that in controls. PWEs also had a higher risk of having a high RLS grade (βepilepsy = 0.390, P < 0.001). Among clinical characteristics of PWEs, migraine, and drug‐resistant epilepsy showed significantly different distributions between those without RLS and those with RLS grade I to III. PWEs with PFO had higher risk of suffering from migraine and drug‐resistant epilepsy (OR in migraine, 2.54, 95% CI, 1.65–3.95; OR in drug‐resistant epilepsy, 1.47, 95% CI, 1.06–2.03).SignificanceThe proportion of PFO was found to be higher in PWE than in controls without epilepsy, especially in patients with drug‐resistant epilepsy, suggesting potential relationship between the two disorders. Large multicentric study will be needed to confirm this finding.

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Lesser Metatarsophalangeal Joints Instability: A Comprehensive Literature Review

Kamel,

Koç

2023

Journal of Foot and Ankle Surgery (Asia Pacific)

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Investigation of patent foramen ovale as a mechanism for brain metastasis in patients without prior lung involvement

Cited by 3 publications

References 32 publications

Cardiac metastasis causes paradoxical malignant embolism

Cardiac metastasis causes paradoxical malignant embolism

Association of patent foramen ovale with epilepsy: A hospital‐based case–control study

Lesser Metatarsophalangeal Joints Instability: A Comprehensive Literature Review

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