Paradoxical Cerebral Embolism as Initial Manifestation of Chronic Thromboembolic Pulmonary Hypertension: A Case Report

Machida, Akira; Soejima, Itsuki; Bo, Takeshi; Amano, Eiichiro; Ota, Katsuya; Kanno, Yoshinori; Kakuta, Tsunekazu

doi:10.1016/j.jstrokecerebrovasdis.2019.06.006

Cited by 4 publications

(2 citation statements)

References 10 publications

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“…Strokes caused by limited lung function may be mediated by pulmonary hypertension. Pulmonary hypertension can increase right atrial pressure, potentially enabling paradoxical emboli to pass through a patent foramen ovale, thereby elevating the risk of stroke ( 31 , 32 ). Systemic inflammation, a hallmark of cardiovascular diseases, contributes to their development and progression.…”

Section: Discussionmentioning

confidence: 99%

The association between declining lung function and stroke risk: insights from an observational study and Mendelian randomization

Wang,

Lin,

Zheng

et al. 2024

Front. Neurol.

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BackgroundStroke, prevalent globally, particularly impacts low- and middle-income countries. Decreased lung function is one of the risk factors for stroke, and there is a lack of sufficient research on the association between the two, especially based on evidence from representative large samples. We aimed to explore the association between lung function and stroke incidence.MethodsWe collected data from 13,371 participants from the 2007–2012 U.S. national cross-sectional study and 11,192 participants from the Chinese national cohort study during the 2011–2018 follow-up period. Multivariate logistic regression and Cox proportional hazards regression were used to assess cross-sectional and longitudinal associations of peak expiratory flow with stroke risks. Additionally, we used publicly available GWAS data from a European population to conduct Mendelian randomization analysis, further exploring the potential causal relationship.ResultsThe results of the cross-sectional study suggest that a decline in peak expiratory flow may be associated with an increased risk of stroke. The cohort study revealed that, compared to the first tertile group, the risk of stroke incidence in the second and third tertile groups of PEF decreased by 19% (hazard ratio (HR) = 0.810, 95%CI = 0.684–0.960) and 21.4% (HR = 0.786, 95%CI = 0.647–0.956), respectively. Mendelian randomization analysis clarified that higher PEF levels are significantly associated with a reduced risk of stroke (OR = 0.852, 95%CI = 0.727–0.997).ConclusionDecreased lung function is a risk factor for stroke. As a simple and accurate indicator of lung function, PEF can be used to monitor lung function in community populations and patients for primary stroke prevention.

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Section: Discussionmentioning

confidence: 99%

The association between declining lung function and stroke risk: insights from an observational study and Mendelian randomization

Wang,

Lin,

Zheng

et al. 2024

Front. Neurol.

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“…Cerebrovascular events can happen for a variety of reasons in patients with preexisting PH including unrecognized arrhythmias, paradoxical emboli, and infection. Paradoxical emboli typically occur in patients with pulmonary to systemic intracardiac shunts, 132 133 and may be precipitated by prolonged immobilization, intravenous fluid or medication (including air emboli), and indwelling line thrombosis or infection. To reduce the risk of paradoxical embolic stroke during intravenous infusions, line filters should be used when administering intravenous treatments.…”

Section: Neurological Emergenciesmentioning

confidence: 99%

Medical Emergencies in Pulmonary Hypertension

Seitler,

Dimopoulos,

Ernst

et al. 2023

Semin Respir Crit Care Med

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The management of acute medical emergencies in patients with pulmonary hypertension (PH) can be challenging. Patients with preexisting PH can rapidly deteriorate due to right ventricular decompensation when faced with acute physiological challenges that would usually be considered low-risk scenarios. This review considers the assessment and management of acute medical emergencies in patients with PH, encompassing both pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), acknowledging these comprise the more severe groups of PH. Management protocols are described in a systems-based approach. Respiratory emergencies include pulmonary embolism, airways disease, and pneumonia; cardiac emergencies including arrhythmia and chest pain with acute myocardial infarction are discussed, alongside PH-specific emergencies such as pulmonary artery dissection and extrinsic coronary artery compression by a dilated proximal pulmonary artery. Other emergencies including sepsis, severe gastroenteritis with dehydration, syncope, and liver failure are also considered. We propose management recommendations for medical emergencies based on available evidence, international guidelines, and expert consensus. We aim to provide advice to the specialist alongside the generalist, and emergency doctors, nurses, and acute physicians in nonspecialist centers. A multidisciplinary team approach is essential in the management of patients with PH, and communication with local and specialist PH centers is paramount. Close hemodynamic monitoring during medical emergencies in patients with preexisting PH is vital, with early referral to critical care recommended given the frequent deterioration and high mortality in this setting.

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Pulmonary hypertension: An unexplored risk factor for stroke in patients with atrial fibrillation

Khattar¹,

Siddiqui²,

Gharib³

et al. 2023

Journal of Stroke and Cerebrovascular Diseases

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Paradoxical Cerebral Embolism as Initial Manifestation of Chronic Thromboembolic Pulmonary Hypertension: A Case Report

Cited by 4 publications

References 10 publications

The association between declining lung function and stroke risk: insights from an observational study and Mendelian randomization

The association between declining lung function and stroke risk: insights from an observational study and Mendelian randomization

Medical Emergencies in Pulmonary Hypertension

Pulmonary hypertension: An unexplored risk factor for stroke in patients with atrial fibrillation

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