Document Detail

Concomitant submassive pulmonary embolism and paradoxical embolic stroke after a long flight: which is the optimal treatment?
MedLine Citation:
PMID:  18799974     Owner:  NLM     Status:  MEDLINE    
Economy class stroke syndrome consists of ischemic stroke due to paradoxical embolism through patent foramen ovale after a long flight. Few cases have been described in the literature to date. The treatment choice could be tricky. We present the case of a 65-year-old woman, admitted for submassive pulmonary embolism after a long flight, that presented a paradoxical embolic stroke through patent foramen ovale shortly after. The patient was treated with intravenous thrombolysis within 1 h of stroke onset with a definite symptoms improvement. Afterwards, intravenous unfractioned heparin was started with strict partial thromboplastin time monitoring. Cerebral computed tomography scan, obtained after 24 and 72 h, ruled out hemorrhage. Warfarin was started after 72 h. Patent foramen ovale was percutaneously closed 3 months after. In the reported case, the treatment with thrombolysis and subsequent heparin infusion was effective and safe. We discuss the rationale for this treatment in the light of literature data.
Pier Camillo Pavesi; Chiara Pedone; Michela Crisci; Alberto Piacentini; Maria Fulvi; Giuseppe Di Pasquale
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of cardiovascular medicine (Hagerstown, Md.)     Volume:  9     ISSN:  1558-2027     ISO Abbreviation:  J Cardiovasc Med (Hagerstown)     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-18     Completed Date:  2008-10-30     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  101259752     Medline TA:  J Cardiovasc Med (Hagerstown)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1070-3     Citation Subset:  IM    
Cardiology Department, Maggiore Hospital, Bologna, Italy.
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MeSH Terms
Anticoagulants / therapeutic use*
Cardiac Surgical Procedures*
Echocardiography, Transesophageal
Embolism, Paradoxical / complications,  drug therapy*,  etiology,  pathology
Foramen Ovale, Patent / complications,  drug therapy*,  etiology,  pathology,  surgery
Heparin / therapeutic use
Pulmonary Embolism / complications,  drug therapy*,  pathology
Stroke / drug therapy*,  etiology,  pathology
Thrombolytic Therapy*
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Ultrasonography, Doppler, Transcranial
Warfarin / therapeutic use
Reg. No./Substance:
0/Anticoagulants; 81-81-2/Warfarin; 9005-49-6/Heparin

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