Stroke Following Peripheral Arterio Venius Malformation Alcohol Embolization – Should We Look for Persisted Foramen Ovale in Advance?

Abstract

Stroke due to paradoxical embolism can be a complication of certain peripheral venous procedures in patients with coexisting patent foramen ovale. There is an established link between venous sclerotherapy and stroke, however there are no known reports of this complication following peripheral arteriovenous embolization.We present a case of a 36-year- old woman who experienced symptoms of disorientation and apraxia following a hypoxic event during percutaneous alcohol embolization of a large arteriovenous malformation in her right gluteal region. An MRI scan revealed multiple foci of restricted diffusion in both cerebral hemispheres corresponding to acute ischemic stroke lesions. As the subsequent work-up revealed patent foramen ovale, we speculate on the pathomechanism of stroke and conclude with a recommendation to screen for patent foramen ovale in patients undergoing peripheral venous procedures including arteriovenous malformation embolization.