Thrombolytic therapy for ischemic stroke secondary to paradoxical embolism in pregnancy: a case report and literature review
| Autor: | Donna Jenny, Yuebing Li, Bryan Kluck, John E. Castaldo, John Margraf Md |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Pregnancy Complications Cardiovascular Infarction Foramen Ovale Patent Pulmonary Artery Tissue plasminogen activator Arteriovenous Malformations Paradoxical embolism Pregnancy Risk Factors Internal medicine medicine.artery medicine Vertebrobasilar Insufficiency Humans Thrombolytic Therapy Vertebrobasilar insufficiency business.industry Pregnancy Complications Hematologic Infarction Middle Cerebral Artery General Medicine Thrombolysis medicine.disease Surgery Radiography Pregnancy Trimester First Hemiparesis Tissue Plasminogen Activator Pulmonary artery Cardiology Patent foramen ovale Female Neurology (clinical) medicine.symptom business medicine.drug |
| Zdroj: | The neurologist. 18(1) |
| ISSN: | 2331-2637 |
| Popis: | INTRODUCTION Thrombolysis for acute ischemic stroke has been rarely administrated during pregnancy. Paradoxical embolism through a patent foramen ovale (PFO) or pulmonary arteriovenous malformation (AVM) is an identified risk factor for ischemic stroke. CASE REPORT We report a 24-year-old woman at 11 weeks gestation who developed a sudden onset of dysarthria, hemiparesis, and hemisensory loss. She was diagnosed as having an ischemic stroke in the left middle cerebral artery (MCA) territory. She was treated with intra-arterial recombinant tissue plasminogen activator with subsequent resolution of her neurological deficits. Further workup revealed the presence of a PFO with a large right-to-left shunt. After being put on antithrombotic therapy, she presented again at 13 gestational weeks with a new ischemic infarction in the vertebrobasilar territory. Her PFO was closed percutaneously under ultrasonic guidance but the right-to-left shunt persisted. After a normal delivery, she was found to have a large pulmonary AVM which was successfully resected without complication. CONCLUSIONS This report describes the successful usage of intra-arterial tissue plasminogen activator for acute ischemic stroke during early pregnancy. In patients with presumed paradoxical embolism, careful attention should be paid to rule out a coexistence of PFO and pulmonary AVM. |
| Databáze: | OpenAIRE |
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