Paradoxical embolism with the development of ischemic stroke on the background of pulmonary embolism: comparative analysis of two clinical cases

Abstract

The development of a neurological deficit clinic in patients with pulmonary embolism (PE) requires a diagnostic search aimed at excluding the phenomenon of paradoxical embolism in the form of transcranial dopplerography (TCDG) with a bubble test, and to clarify the features of intracardiac hemodynamics – transesophageal echocardiography (TEE). Material and methods. The article presents two clinical examples of the development of PE in the form of embolic ischemic stroke (IS) against the background of deep vein thrombosis of the lower extremities, PE, patent foramen ovale (PFO) in combination with an atrial septal aneurysm. Results and discussion. In the first case, the right-left shunt was confirmed by TKDG with a bubble test, in the second example, during routine transthoracic echocardiography, a ribbon thrombus prolapsing through the PFO was visualized. In our opinion, PE is a possible mechanism of IS in patients with venous thromboembolic events. Consequently, it is necessary to plan a “bubble test” for verifying the cause of a stroke. Conclusions. The management of patients with PE and IS was individual and required a team approach, including the use of thrombolytic therapy, the selection of an anticoagulant therapy regimen, choice of conservative/invasive tactics for the treatment of patients.

Keywords

• paradoxical embolism
• ischemic stroke
• pulmonary embolism