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Neurocritical Care
Published in: Neurocritical Care 2/2019

01-04-2019 | A Day in the Life of a Neurocritical Care Trainee

A Rare Case of Paradoxical Embolization During Thrombolysis for Pulmonary Embolus

Authors: Mitchell Onwochei-Ashei, William T. McGee

Published in: Neurocritical Care | Issue 2/2019

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Excerpt

Paradoxical embolization occurs when an embolus formed in the systemic venous circulation enters the systemic arterial circulation via an intracardiac shunt. The most common intracardiac shunt is a patent foramen ovale (PFO) present in approximately 25% of adults [1]. Other shunts which could allow for paradoxical embolization to occur include atrial septal defect, ventricular septal defect or extracardiac communications such as a pulmonary arteriovenous malformation [2]. …
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Lamy C, Giannesini C, Zuber M, et al. Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA study. Atrial septal aneurysm. Stroke. 2002;33:706.CrossRefPubMed
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Carvalho J, Pinto J, Vidoedo J, Tenreiro J, Albuquerque R. Paradoxical peripheral embolism—a rare and underestimated event. Eur J Vasc Endovasc Surg. 2009;37:619.CrossRef
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Langholz D, Louie E, Konstadt S, Rao T, Scanlon P. Transesophageal echocardiographic demonstration of distinct mechanisms for right to left shunting across a patent foramen ovale in the absence of pulmonary hypertension. J Am Coll Cardiol. 1991;18(4):1112.CrossRefPubMed
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Oldenbüttel P, Antoni DH, Krieg HJ, Engel M, Wencke K, Delius W. Combined lytic and heart surgical therapy of in open foramen ovale incarcerated giant thrombus with pulmonary and cerebral embolization. Z Kardiol. 1997;86(9):732–7.CrossRefPubMed
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Pavesi PC, Pedone C, Crisci M, Piacentini A, Fulvi M, Di Pasquale G. Concomitant submassive pulmonary embolism and paradoxical embolic stroke after a long flight: which is the optimal treatment? J Cardiovasc Med (Hagerstown). 2008;9(10):1070–3.CrossRef
Metadata
Title
A Rare Case of Paradoxical Embolization During Thrombolysis for Pulmonary Embolus
Authors
Mitchell Onwochei-Ashei
William T. McGee
Publication date
01-04-2019
Publisher
Springer US
Published in
Neurocritical Care / Issue 2/2019
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-018-0615-8

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