Dyspnoeic dysphasia: A series of unfortunate events

2011 ◽  
Vol 10 (4) ◽  
pp. 203-205
Author(s):  
GW Sewell ◽  
◽  
DJB Marks ◽  
C Hasford ◽  
◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Contrast Echocardiography ◽  
Paradoxical Embolism ◽  
Sudden Onset ◽  
Sensory Loss ◽  
Foramen Ovale ◽  
Surgical Closure ◽  
Pulmonary Angiogram ◽  
Ct Pulmonary Angiogram ◽  
Ischaemic Attack

We describe a case of a 56 year old man with no previous medical history who presented with sudden onset dyspnoea, expressive dysphasia, and right arm sensory loss and paresis. A diagnosis of bilateral pulmonary embolism and transient cerebral ischaemic attack was confirmed by CT pulmonary angiogram and MRI. Paradoxical embolism through an occult patent foramen ovale (PFO) was subsequently proven by contrast echocardiography. This case highlights a number of short and long-term management conundrums, that to date are incompletely addressed by clinical trials. These include timing of anticoagulation in patients with both venous thromboembolism and cerebral infarction, and the risk:benefit ratio of surgical closure of patent foramen ovale.

scholarly journals Contrast Echocardiography and Migraine in Divers with Patent Foramen Ovale

2009 ◽  
Vol 36 (6) ◽  
pp. 740-744 ◽  
Author(s):  
Roberto Di Fabio ◽  
Elisabetta Giugni ◽  
Imerio Angeloni ◽  
Nicola Vanacore ◽  
Carlo Casali ◽  
...  
Keyword(s):  
Preliminary Data ◽  
Patent Foramen Ovale ◽  
Contrast Echocardiography ◽  
Paradoxical Embolism ◽  
Medium Size ◽  
Minimal Size ◽  
Foramen Ovale ◽  
Safe Method ◽  
Cerebral Embolization ◽  
Contrast Solution

Background:It has been proposed that the patent foramen ovale (PFO) may be associated with migraine, in particular migraine with aura. However, it is not clear whether paradoxical embolism triggers crises of headache. Cerebral embolization is provoked in subjects with PFO through contrast echocardiography, a safe method to diagnose the presence of foramen ovale pervium.Methods:Twenty-four men practicing diving, an activity characterized by increased prevalence of PFO and migraine, underwent trans-thoracic echocardiography with contrast solution, composed of saline and air mixture and checked for the occurrence of migraine in the following 24 hours.Results:A PFO (five of minimal size, i.e. visible only during Valsalva, one of small and two of medium size) was detected in 8/24 divers (33%). No one reported headache over the 24 hours after the procedure.Discussion:Our preliminary data suggest that cerebral micro-embolism, provoked by contrast echocardiography, does not systematically trigger migraine crises when a minimal-to-medium sized patent foramen ovale is present.

Surgical Patent Foramen Ovale Closure for Prevention of Paradoxical Embolism–Related Cerebrovascular Ischemic Events

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Joseph A. Dearani ◽  
Baran S. Ugurlu ◽  
Gordon K. Danielson ◽  
Richard C. Daly ◽  
Christopher G. A. McGregor ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Patent Foramen Ovale ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Surgical Closure ◽  
Ischemic Events ◽  
Pfo Closure

Background —The role of surgical closure of patent foramen ovale (PFO) for cerebral infarction (CI) or transient ischemic attack (TIA) resulting from paradoxical embolism is unclear, and its effect on recurrence is unknown. Our objective was to determine the outcome of surgical closure of PFO in patients with a prior ischemic neurological event, define the rate of CI or TIA recurrence after PFO closure, and identify risk factors for these recurrences. Methods and Results —We retrospectively analyzed 91 patients (58 men, 33 women) with ≥1 previous cerebrovascular ischemic events who underwent surgical PFO closure between April 1982 and March 1998. The presence of a PFO with a right-to-left shunt was confirmed with transesophageal echocardiography. Mean age was 44.2±12.2 years. The index event was a CI in 59 and a TIA in 32; a Valsalva-like episode preceded the event in 15 patients. Deep venous thrombosis was documented in 9 patients, and a hypercoagulable state was identified in 10. Surgical closure was performed with extracorporeal circulation by either direct suture (n=82) or patch closure (n=9). Limited incisions were used in 18.7% of patients. There was no operative mortality. Morbidity included transient atrial fibrillation (n=11), pericardial drainage for effusion (n=4), exploration for bleeding (n=3), and superficial wound infection (n=1). Follow-up totaled 176.3 patient-years, and mean follow-up was 2.0 years. No one had a CI, and 8 had a TIA during follow-up, with 1 caused by temporal arteritis. Transesophageal echocardiography demonstrated all closures to be intact in these patients. The overall freedom from TIA recurrence during follow-up was 92.5±3.2% at 1 year and 83.4±6.0% at 4 years. Having multiple neurological events before PFO closure was the only significant risk factor for TIA or CI recurrence after closure by univariate analysis ( P =0.05); the small number of post-PFO closure cerebral ischemic events precluded multivariate analysis. Conclusions —Surgical closure of PFO can be performed with minimal morbidity and mortality. PFO closure may decrease the risk of recurrent stroke or TIA and may avoid lifelong anticoagulation in the young adult if there is no other indication. Recurrent cerebrovascular ischemic events after surgery should prompt further evaluation to identify causes other than paradoxical embolism.

Transcatheter closure of the patent foramen ovale in children: intermediate-term follow-up results

2017 ◽  
Vol 27 (8) ◽  
pp. 1545-1549
Author(s):  
Kutay Sel ◽  
Hakan H. Aykan ◽  
Derya Duman ◽  
Ebru Aypar ◽  
Süheyla Özkutlu ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Transcatheter Closure ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Limited Data ◽  
Common Procedure ◽  
Ischaemic Attack ◽  
The Mean ◽  
The Right

AbstractThe patent foramen ovale is almost a normal anatomical hole between the atria with ~30% incidence in the general population. It has been suggested that the patent foramen ovale is the cause of some neurological events, which is explained by paradoxical embolism. Transcatheter closure of the patent foramen ovale is a common procedure in adult patients with cerebral ischaemic events, but there are limited data investigating the results in children. Between January, 2005 and February, 2014, 17 patients’ patent foramen ovales were closed by the transcatheter approach in our department. The indications for closure were transient ischaemic attack in 10 patients, stroke in four patients, and migraine in three patients. The mean age and mean weight at the time of the procedure were 11.1±3.7 years and 42.1±15.4 kg, respectively. We asked our patients whether their previous ailments continued. All patients responded to the study survey. In 15 patients, ailments did not continue after patent foramen ovale closure and they significantly decreased in two of them. We suggest that under the right conditions device closure of the patent foramen ovale is a safe solution for these cryptogenic ischaemic events and migraine.

Patent Foramen Ovale, the Role of Antiplatelet Therapy Alone or Anticoagulant Therapy Alone Versus Device Closure for Cryptogenic Stroke: A Review of the Literature and Current Recommendations

2020 ◽  
Vol 18 (2) ◽  
pp. 135-150
Author(s):  
Harsha S. Nagarajarao ◽  
Chandra P. Ojha ◽  
Archana Kedar ◽  
Debabrata Mukherjee
Keyword(s):  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Narrow Channel ◽  
Paradoxical Embolism ◽  
Current Evidence ◽  
Foramen Ovale ◽  
The Right ◽  
The Relationship ◽  
Current Guidelines

: Cryptogenic stroke and its relation to the Patent Foramen Ovale (PFO) is a long-debated topic. Recent clinical trials have unequivocally established the relationship between cryptogenic strokes and paradoxical embolism across the PFO. This slit-like communication exists in everyone before birth, but most often closes shortly after birth. PFO may persist as a narrow channel of communication between the right and left atria in approximately 25-27% of adults. : In this review, we examine the clinical relevance of the PFO with analysis of the latest trials evaluating catheter-based closure of PFO’s for cryptogenic stroke. We also review the current evidence examining the use of antiplatelet medications versus anticoagulants for stroke prevention in those patients with PFO who do not qualify for closure per current guidelines.

Paradoxical embolism through patent foramen ovale as a cause of myocardial infarction

2021 ◽  
Author(s):  
Naim Mridha ◽  
Eloise Ward ◽  
Samual Hayman ◽  
Arun Dahiya ◽  
Sandhir Prasad
Keyword(s):  
Myocardial Infarction ◽  
Patent Foramen Ovale ◽  
Paradoxical Embolism ◽  
Foramen Ovale
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