scholarly journals Cryptogenic stroke. Part 2: paradoxical embolism

2021 ◽  
pp. 16-33
Author(s):  
A. A. Kulesh ◽  
D. A. Demin ◽  
A. V. Belopasova ◽  
S. A. Mekhryakov ◽  
O. I. Vinogradov ◽  
...  

Cryptogenic stroke (CS) is defined as a subtype of stroke associated with a heterogeneous group of pathogenetic mechanisms that remained undetermined in the course of advanced diagnostic research. One third or fourth of the ischemic strokes is cryptogenic. Paradoxical embolism is considered the important cause of cryptogenic stroke and transient ischaemic attack (TIA) in young patients. It may occur via the following: patent foramen ovale (PFO), atrial septal defect (ASD), and pulmonary arteriovenous malformation (PAVM). When interviewing patients with suspected paradoxical embolism to obtain their health history, a practitioner should consider factors associated with Valsalva maneuvers, deep vein thrombosis/PE or predisposing conditions or situations, as well as symptoms of hereditary hemorrhagic telangiectasia (telangiectasia of the skin and mucous membranes, hemorrhagic syndrome) and pulmonary arteriovenous malformations (PAVMs) (shortness of breath, hemoptysis). If paradoxical embolism is suspected, it is necessary to conduct a stepwise diagnostic search, including transcranial Doppler ultrasound with bubble test, contrast-enhanced transesophageal echocardiography, and CT angiopulmonography. Diagnosis of relevant clinical conditions involves a search of atrial tachyarrhythmias, deep vein thrombosis, and thrombophilia. As the pathogenetic role of ASD and PAVMs in the development of embolic cryptogenic stroke is beyond doubt, the clinical significance of PFO should be determined taking into account several factors, including the presence of deep vein thrombosis/PE, the severity of the right-left shunt, the presence of ASD, the RoPE score, and detection of thrombophilia. The secondary prevention techniques of ischemic stroke or TIA with underlying PFO should be selected on a case-by-case basis, depending on the clinical significance of the anomaly, comorbid pathology, life expectancy of the patient: endovascular occlusion, anticoagulant or antiplatelet therapy. The secondary prevention with underlying ASD and LAVM includes surgical techniques such as endovascular occlusion or open surgery followed by monitoring of their effectiveness.

2008 ◽  
Vol 64 (4) ◽  
pp. 1133-1135 ◽  
Author(s):  
Cyrus Edibam ◽  
David J. Morgan ◽  
Sudhakar V. Rao ◽  
Arieh Keren ◽  
Jenny Deague

2016 ◽  
Vol 18 ◽  
pp. 41-44 ◽  
Author(s):  
Adil Can Güngen ◽  
Hikmet Çoban ◽  
Yusuf Aydemir ◽  
Hasan Düzenli

1996 ◽  
Vol 2 (1) ◽  
pp. 55-59 ◽  
Author(s):  
Alberto Cogo ◽  
Anthonie W. A. Lensing ◽  
Paolo Prandoni ◽  
Paolo Simioni ◽  
Enrico Bernardi ◽  
...  

The relevance of congenital thrombophilia in the pathogenesis of venous thromboembolism in young patients is still debated. In a case-control study, plasma antigen and activity of antithrombin, protein C, and plas minogen, as well as total and free protein S were mea sured in a series of 166 consecutive outpatients aged less than 50 years, who underwent contrast venography be cause of clinically suspected deep-vein thrombosis (DVT). The presence of major acquired risk factors for venous thrombosis was also recorded. The association between DVT and inherited thrombophilia or acquired risk factors was initially described using crude odds ratios (OR). Subsequently, a logistic regression model was used to test their independence. Of the 166 patients included, venography showed an acute DVT in 73 (cases), whereas it was normal in the remaining 93 (controls). Major ac quired risk factors were identified in 51 cases and in 20 controls (crude OR: 8.5; 95% CI: 4.1-17.1). Inherited thrombophilia was detected in seven cases and in one control (crude OR: 9.8; 95% CI: 1.2-81.2). Inherited thrombophilia was equally distributed between patients with secondary and idiopathic DVT and was proved to be independent from acquired risk factors in the regression model. Inherited thrombophilia is an independent risk factor for DVT in young patients. However, its preva lence in unselected cases with the first episode of DVT is low.


2016 ◽  
Vol 31 (1_suppl) ◽  
pp. 48-55 ◽  
Author(s):  
Christian-Alexander Behrendt ◽  
Franziska Heidemann ◽  
Henrik Christian Rieß ◽  
Edgar Kleinspehn ◽  
Tobias Kühme ◽  
...  

The postthrombotic syndrome counts as a frequent long-term complication after deep vein thrombosis with approximately 20%–50% of affected patients after deep vein thrombosis. The earliest that diagnosis of postthrombotic syndrome can be made is 6 months after deep vein thrombosis. Most patients suffer from swelling and chronic pain. In all, 5%–10% of patients may even develop venous ulcers. The complex etiology consists of limited venous drainage because of chronic occlusions and secondary insufficiencies of venous valves inducing non-physiological venous reflux. Conservative management, first of all compression therapy, is of crucial importance in treatment of postthrombotic syndrome. Endovascular and open surgical techniques can additionally be used in a small subgroup of patients. Although rarely performed, this article illuminates the open surgical techniques in treatment of postthrombotic syndrome such as venous bypass surgery, valve repair and varicose vein surgery.


10.5772/31376 ◽  
2012 ◽  
Author(s):  
Massimiliano Bianchi ◽  
Lorenzo Faggioni ◽  
Virna Zampa ◽  
Gina DErrico ◽  
Paolo Marraccini ◽  
...  

Sign in / Sign up

Export Citation Format

Share Document