Document Detail

Thrombolytic therapy for ischemic stroke secondary to paradoxical embolism in pregnancy: a case report and literature review.
MedLine Citation:
PMID:  22217616     Owner:  NLM     Status:  MEDLINE    
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.
Yuebing Li; John Margraf; Bryan Kluck; Donna Jenny; John Castaldo
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  The neurologist     Volume:  18     ISSN:  2331-2637     ISO Abbreviation:  Neurologist     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-05     Completed Date:  2012-04-25     Revised Date:  2014-11-05    
Medline Journal Info:
Nlm Unique ID:  9503763     Medline TA:  Neurologist     Country:  United States    
Other Details:
Languages:  eng     Pagination:  44-8     Citation Subset:  IM    
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MeSH Terms
Arteriovenous Malformations / complications*
Foramen Ovale, Patent / complications*,  therapy
Infarction, Middle Cerebral Artery / complications,  drug therapy*
Pregnancy Complications, Cardiovascular / therapy
Pregnancy Complications, Hematologic / drug therapy*
Pregnancy Trimester, First
Pulmonary Artery / abnormalities*,  radiography
Risk Factors
Thrombolytic Therapy
Tissue Plasminogen Activator / therapeutic use*
Vertebrobasilar Insufficiency / complications,  drug therapy
Reg. No./Substance:
EC Plasminogen Activator

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