Patent Foramen Ovale and Ischemic Stroke in Patients With Pulmonary Embolism

Moigne, Emmanuelle Le; Timsit, Serge; Salem, Douraı̈ed Ben; Didier, Romain; Jobic, Yannick; Paleiron, Nicolas; Mao, Raphaël Le; Joseph, Thierry; Hoffmann, Clément; Dion, Angélina; Rousset, J.; Gal, Grégoire Le; Lacut, Karine; Leroyer, Christophe; Mottier, Dominique; Couturaud, Francis

doi:10.7326/m18-3485

Cited by 51 publications

(29 citation statements)

References 32 publications

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“…Le Moigne et al presented the most extensive prospective study to date in patients with acute PE, identifying the presence of ischemic stroke and PFO, with results confirming the presence of ischemic stroke in 21.4% and 5.5% with and without PFO, respectively. This study confirms that PFO and aneurysmatic atrial septum are risk factors for stroke [1].…”

Section: Discussionsupporting

confidence: 87%

“…It should always be considered in a patient with pulmonary embolism (PE) associated with systemic thromboembolism. The risk of stroke is four times higher in patients with PFO as compared to patients without PFO [1]. Contrast transesophageal echocardiogram (TEE) was more sensitive than contrast transthoracic echocardiogram (TTE) in identifying PFO [2].…”

Section: Introductionmentioning

confidence: 99%

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An Elderly Man with Syncope, Hypoxia, and Confusion: A Case Report and Review of Literature

Konala

Naramala

Adapa³

et al. 2019

Cureus

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Controversies exist regarding the treatment of acute massive pulmonary embolism (PE) with anticoagulation alone or with thrombolytic therapy. Paradoxical embolism in the presence of a patent foramen ovale (PFO) is a rare but well-known entity and should always be looked for in case of a PE associated with systemic thromboembolism. We report a case of acute sub-massive PE treated with thrombolytic therapy in an elderly gentleman who had a paradoxical embolism and ischemic stroke as a result of a clot traversing through a PFO. We discussed diagnostic modalities, treatment of choice, and associated controversies in management.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

An Elderly Man with Syncope, Hypoxia, and Confusion: A Case Report and Review of Literature

Konala

Naramala

Adapa³

et al. 2019

Cureus

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“…We found six studies; detailed analyses regarding population characteristics, diagnostic measures and time to interventions after admission are outlined in Table 3 (14,(24)(25)(26)(27)(28). Overall, ischemic stroke was reported to be diagnosed within 2-22 days following after admission and was more frequent in patients with overt PFO with four studies revealing statistical significance (14,25,27,28).…”

Section: Studies On the Frequency Of Ischemic Strokes In Patients Witmentioning

confidence: 99%

Deep Vein Thrombosis and Pulmonary Embolism Among Patients With a Cryptogenic Stroke Linked to Patent Foramen Ovale—A Review of the Literature

2020

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Background: Venous thromboembolism (VTE) can occur simultaneously with a cryptogenic stroke (CS) linked to patent foramen ovale (PFO), given paradox thromboembolism as potential stroke cause. However, little is known on the frequency of concomitant VTE and CS. We aimed to review the literature on the frequency of VTE in patients with CS linked to PFO (primary aim) and of ischemic stroke (IS) among patients with pulmonary embolism (PE) (secondary aim). Methods: We performed a Medline search for cohort studies, written in English, with the following characteristics: (a) enrolling patients hospitalized for an acute ischemic stroke undergoing a work-up for deep venous thrombosis (DVT) and/or PE. To be included in this review, a study had to have at least a subgroup of patients with PFO; (b) the time interval between the index stroke and the work-up had to be within 40 days and the studies had to differentiate between DVT and PE. For the secondary aim, studies had to include patients with acute PE, known PFO-status and routine brain imaging on admission or within 1 year. Results: We found eight studies reporting on the frequency of VTE after an acute CS linked to PFO. Concerning DVT, the reported frequency ranged between 7 and 27%; concerning PE, it lied between 4.4 and 37%. Six studies assessed the frequency of ischemic brain lesions among patients with an acute PE. In all studies, the presence of PFO was associated with ischemic brain lesions, both at baseline and follow-up. Conclusion: VTE can be detected in patients with CS linked to PFO. While-based on the presented literature-routine screening for VTE in patients with CS linked to PFO does not appear justified, history taking, and clinical exam should consider concomitant VTE. Whenever clinically suspected, the threshold to trigger ancillary testing for VTE should be low. Among patients with an acute PE and PFO, vigilance for new neurologic deficits should be increased, with a low threshold for brain imaging.

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“…Among the causes of intracardiac shunt, patent foramen ovale (PFO) accounts for 25–35% [ 2 ]. The presence of a PFO is significantly associated with stroke recurrence in patients with pulmonary embolism (PE) [ 3 , 4 ]. We report the management of a 31-year-old patient with paradoxical cerebral embolism associated with a spontaneous VTE.…”

Section: Introductionmentioning

confidence: 99%

Cerebral paradoxical embolism associated with patent foramen ovale and idiopathic venous thromboembolism in a 31-year-old patient

Bekouti

Ranaivosoa

Adossou

et al. 2020

Oxford Medical Case Reports

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Paradoxical embolism is the passage of venous thrombi into the arterial circulation through a pulmonary or intracardiac shunt. We report the management of a 31-year-old patient who initially presented with chest pain and right brachiofacial paresis. A diagnosis of paradoxical cerebral embolism associated with a spontaneous venous thromboembolism and a patent foramen ovale was made. The patient benefited from thrombolytic therapy and lifelong anticoagulation with good recovery. This case showed that percutaneous closure of a patent foramen ovale needs to be discussed individually.

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Patent Foramen Ovale and Ischemic Stroke in Patients With Pulmonary Embolism

Cited by 51 publications

References 32 publications

An Elderly Man with Syncope, Hypoxia, and Confusion: A Case Report and Review of Literature

An Elderly Man with Syncope, Hypoxia, and Confusion: A Case Report and Review of Literature

Deep Vein Thrombosis and Pulmonary Embolism Among Patients With a Cryptogenic Stroke Linked to Patent Foramen Ovale—A Review of the Literature

Cerebral paradoxical embolism associated with patent foramen ovale and idiopathic venous thromboembolism in a 31-year-old patient

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