Neurological Complications of Pulmonary Embolism: a Literature Review

Desai, Parth; Krepostman, Nicolas; Collins, Matthew; Sirkar, Sovik De; Hinkleman, Alexa; Walsh, Kevin; Fareed, Jawed; Darki, Amir

doi:10.1007/s11910-021-01145-8

Cited by 9 publications

(8 citation statements)

References 165 publications

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“…Seizure is classified as an atypical presentation of PTE which occurs in less than 1% of PTE cases [ 9 ]. PTE has different etiologies such as venous stasis as in immobilization, surgery, trauma, hypercoagulable states as in pregnancy, oral contraceptive consumption, estrogen replacement therapy, malignancy, and hereditary deficiency of factors and anti-phospholipid syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…PTE has different etiologies such as venous stasis as in immobilization, surgery, trauma, hypercoagulable states as in pregnancy, oral contraceptive consumption, estrogen replacement therapy, malignancy, and hereditary deficiency of factors and anti-phospholipid syndrome. Mortality in PTE patients who present with seizure have been estimated as approximately 55%, mostly due to the delay in diagnosis [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

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A Rare Presentation of Pulmonary Thromboembolism as Seizure

2022

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Acute pulmonary thromboembolism is a critical and sometimes fatal event that is difficult for clinicians to diagnose because of its various initial manifestations. Here, we report a previously healthy 50-year-old man without any history of seizures who presented to the emergency ward with the new-onset seizure. Neurology consult was performed, but found no focal neurological deficits. The diagnosis of massive pulmonary embolism was confirmed by echocardiography and pulmonary CT angiography. Alteplase and heparin with therapeutic dosage were started for the patient. After initiating treatment, patient’s dyspnea, arterial O2 saturation, and general condition were significantly improved. Echocardiography was repeated and showed a smaller right ventricle size and lower pulmonary artery pressure than the first echocardiography.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Rare Presentation of Pulmonary Thromboembolism as Seizure

2022

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“…Although acknowledged, seizures have not been shown to be a common side effect of PE [ 29 ]. The pathophysiology suggests that PE may cause transient right ventricular failure that leads to decreased cardiac output and transitory cerebral hypoperfusion with the potential to trigger “hypoxia-driven cardiogenic seizures” [ 30 ]. Given that MTS is highly associated with an increased risk of thrombo-emboli, it is plausible that a condition causing transient hypoxia could lead to seizures.…”

Section: Discussionmentioning

confidence: 99%

Seizures, deep vein thrombosis, and pulmonary emboli in a severe case of May–Thurner syndrome: a case report

et al. 2022

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Background May–Thurner syndrome is a vascular disorder caused by the right common iliac artery compressing the left common iliac vein against the lumbar spine, causing distal venous stasis and potentially leading to fibrous change in the venous wall structure. Although May–Thurner syndrome is most commonly discovered in females upon investigation of new-onset deep vein thrombosis, we present the case of an otherwise healthy 29-year-old male with severe May–Thurner syndrome who presented with seizures, bilateral deep vein thrombosis, and diffuse pulmonary emboli. Seizures constituted the earliest presenting symptoms for the patient. Although it is difficult to prove that the patient’s seizures were related to the May–Thurner syndrome, this possible association renders this case extraordinary. Case presentation This report describes the case of a 29-year-old previously healthy white male with a severe case of left-sided May–Thurner syndrome that required extensive medical and interventional treatment. The patient experienced two seizures, one month apart, both of which occurred while residing at high altitude. The patient had no prior history of seizures, and epilepsy was ruled out. Three weeks after the second seizure, he presented to the emergency room with hemoptysis, dyspnea, and severe leg pain. Sites of thrombus were confirmed in both legs and diffusely in the lungs. Etiological work-up after treatment with intravenous tissue plasminogen activator revealed May–Thurner syndrome. Hematology workup including genetic testing showed no evidence of coagulopathy. Bilateral common iliac venous stents were placed to attempt definitive treatment. Despite stenting, the patient had another thrombotic event with associated sequelae after discontinuation of anticoagulation. The patient has not had another seizure since the stents were placed. Despite the negative testing, the patient remains on lifelong chemoprophylaxis in the event of an undiscovered hypercoagulopathy. Conclusions The care team theorizes that the seizures resulted from hypoxia due to May–Thurner syndrome-induced hemostasis and associated thrombotic events, the high-altitude location of his residence at the time he experienced the seizures, and shallow breathing during sleep. For patients with lower limb venous thrombosis, May–Thurner syndrome should be considered in the differential diagnosis. Endovascular treatment followed by extended prophylactic anticoagulation therapy until the patient is determined to be no longer at risk for thrombosis is recommended. Post-venoplasty thrombosis is a common complication of endovascular treatment of May–Thurner syndrome and should be carefully monitored.

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“…They have been noted in cardiopulmonary diseases such as long QT syndrome, severe bradycardia, systemic hypertension, aortic dissection, and cardiac arrest ( 8 – 11 ). However, new-onset seizure as the clinical presentation of MPE has rarely been reported; thus, recognition is more difficult, timely management is delayed, and consequently, it has a much higher risk of death and poor outcomes ( 3 , 5 , 6 , 12 , 13 ). We summarized the published cases of PE with seizure in Supplementary Table 1 ( 13 – 31 ).…”

Section: Discussionmentioning

confidence: 99%

“…Seizure commonly presents in emergency departments (EDs) ( 5 ). However, the incidence of MPE presenting as a seizure is <1%, but when it presents as a seizure, the reported mortality rate is 54.5% ( 6 ). To our knowledge, there has been no report of successful percutaneous catheter-directed treatment (CDT) of MPE presenting with new-onset seizures and cardiac arrest.…”

Section: Introductionmentioning

confidence: 99%

Seizure as the clinical presentation of massive pulmonary embolism: Case report and literature review

et al. 2022

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Massive pulmonary embolism (MPE) is a high-risk medical emergency. Seizure as the clinical presentation of MPE is extremely rare, and to our knowledge, there have been no reports on successful percutaneous, catheter-based treatment of MPE presenting with new-onset seizures and cardiac arrest. In this report, we discuss the case of a 64-year-old woman who presented with an episode of seizure that lasted 5 h. Seizure occurred four times within 12 h after arrival at the hospital, and in the end, she sustained a cardiac arrest. The patient had no past history of seizure or cardiopulmonary disease. Bilateral MPE was detected by a computed tomography pulmonary angiogram, and she was successfully treated with percutaneous, catheter-directed anticoagulant therapy. Pulmonary embolism-related seizures are more difficult to diagnose and have higher mortality rates than seizures. MPE should be suspected in patients presenting with new-onset seizures and hemodynamic instability.

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Neurological Complications of Pulmonary Embolism: a Literature Review

Cited by 9 publications

References 165 publications

A Rare Presentation of Pulmonary Thromboembolism as Seizure

A Rare Presentation of Pulmonary Thromboembolism as Seizure

Seizures, deep vein thrombosis, and pulmonary emboli in a severe case of May–Thurner syndrome: a case report

Seizure as the clinical presentation of massive pulmonary embolism: Case report and literature review

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