Stroke due to Paradoxical Embolization Related to Fibroid Uterus Enlargement Compressing the Right Common Iliac Vein

Abstract

Stroke in young women is commonly cryptogenic or associated with an underlying hypercoagulable state (e.g., hormonal contraception). Paradoxical embolization has been postulated as a potential risk factor for stroke in young adults. Many sources of venous thrombosis leading to paradoxical embolization have been described. There have been few reported cases of uterine enlargement leading to iliac vein compression and paradoxical embolization. We present the case of a young adult woman who had a left middle cerebral artery infarction related to patent foramen ovale and right common iliac vein compression from an enlarged fibroid uterus.

Recurrent stroke in a reproductive age women with patent foramen ovale

“…Although the limb and pelvic duplex venous ultrasound findings were unremarkable in the present case, the thrombus was presumed to be of venous origin because systemic venous embolism is common in adults, is typically characterized by silent superficial venous thrombus formation, and can generate numerous migrating emboli [ 1 , 8 ]. Additionally, the patient was taking a COC, which was an overt risk factor for thromboembolism.…”

Embolic Stroke in Setting of Iliac Vein Stenosis in an Avid Cyclist

“…Another syndrome of iliac vein stenosis, May–Thurner syndrome, was reported to be associated with cryptogenic stroke and PFO. 6-8 Although specific recommendations for stroke prevention in May–Thurner syndrome are lacking, current guidelines recommend anticoagulation in patients with ischemic stroke and a venous source of embolism, 13 which is the likely mechanism in May–Thurner syndrome causing stroke. The data regarding concurrent PFO closure in patients with suspected cryptogenic stroke and May–Thurner syndrome are also lacking.…”

“…5 For instance, May–Thurner syndrome, otherwise known as “iliac vein compression syndrome,” is an anatomical variant where the left common iliac vein is compressed by the right common iliac artery, which can lead to deep vein thrombosis and subsequent embolism, including ischemic stroke. 6-8 Here we present a case of a young healthy male cyclist with frontal lobe cortical infarcts, a right-to-left cardiac shunt and a long area of high-grade stenosis of the right iliac vein.…”