Stroke and Respiratory Failure: Mind the Shunt!

Abstract

When stroke patients present with respiratory failure, the first thought that clinicians have is that it is probably related to aspiration pneumonia. However, other causes should be considered, such as intracardiac or intrapulmonary shunts, that could present with paradoxical embolism. Paradoxical embolism is a rare entity defined by the occurrence of a venous thrombotic event associated with a systemic arterial embolism. Frequently, paradoxical embolism presents with platypnoea-orthodeoxia syndrome. Platypnoea-orthodeoxia syndrome is uncommon and is characterized by dyspnoea and hypoxaemia induced by orthostatic position, where symptoms and oxygenation are relieved by recumbency. The authors report a case of a patient who presented with an ischaemic stroke and progression to platypnoea-orthodeoxia syndrome with documentation of simultaneous pulmonary embolism and pulmonary arteriovenous malformations.

Myocardial Infarction Due to Paradoxical Thromboembolism Originating From Distal Lower Extremity Deep Vein Thrombosis (LEDVT)

“…PDE may also occur in association with atrial septal defects (ASDs), ventricular septal defects (VSDs), or pulmonary arteriovenous malformations (PAVMs) [7]. In contrast to PFO, patients with VSD causing Eisenmenger syndrome or PAVM have persistent right-to-left shunts that can result in PDE [3,12].…”

Development and validation of a clinical prediction model for concurrent pulmonary infection in convalescent patients with intracerebral hemorrhage

“…Pulmonary infections, while not signi cantly affecting acute phase mortality, elevate the risk of death and lead to longer hospital stays during the recovery phase, potentially exposing patients to more pathogens [22,23] . Moreover, these infections can lead to severe complications like sepsis and respiratory failure [21,24,25] . highlighting the critical need for early detection and management of high-risk ICH patients.…”

Development and validation of a clinical prediction model for concurrent pulmonary infection in convalescent patients with intracerebral hemorrhage

“…Another study showed that as one of the important factors, pulmonary infection leads to prolonged hospitalization of ICH patients, which makes patients more likely to be exposed to pathogens during hospitalization, thus aggravating pulmonary infection or causing other infections [23]. Pulmonary infection may also lead to sepsis, respiratory failure and epilepsy in convalescent patients with intracerebral hemorrhage [21,24,25]. Therefore, pulmonary infection has a huge impact on the prognosis of convalescent patients with intracerebral hemorrhage, and it is necessary for clinical staff to identify ICH patients at high risk of pulmonary infection as early as possible.…”