1
|
Gritsch D, Abdallah A, Taylor AM, Mesbah Z, Demaerschalk BM. Acute Ischemic Stroke as a Result of Paradoxical Embolus in a Patient with Renal Cell Carcinoma, Intravenous Tumor Thrombus Extension, and Patent Foramen Ovale. Neurologist 2021; 25:137-140. [PMID: 32925485 DOI: 10.1097/nrl.0000000000000276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Patent foramen ovale is a common congenital cardiac abnormality. An association with acute ischemic stroke is well described. Extension of renal cell carcinoma (RCC) into the adjacent veins is common. Surgical resection is felt to be an effective approach to treatment, even in the setting of extensive venous involvement. CASE REPORT A 55-year-old woman with recently diagnosed right renal mass and cavoatrial tumor thrombus was transferred to our facility for surgical resection. She subsequently underwent open radical right nephrectomy, regional lymph node dissection, inferior vena cava and right atrial tumor thrombectomy, and resection of the infrahepatic vena cava. An intraoperative transesophageal echocardiogram confirmed the absence of tumor thrombus from the inferior vena cava and right atrium and also identified a patent foramen ovale (PFO). Upon weaning sedation, she was noted to be agitated and have left hemiplegia. Her National Institutes of Health Stroke Scale (NIHSS) was 30 and Glasgow Coma Scale (GCS) 6. The computerized tomography scan of head revealed extensive hypoattenuation right in the middle and left posterior cerebral artery territories. There was associated cerebral edema and 5-mm midline shift. In the setting of devastating neurological injury, her family elected to transition to comfort care and the patient died on the postoperative day 7. CONCLUSIONS This is the first reported case of intraoperative paradoxical embolism in the setting of RCC with cavoatrial extension and PFO. The presence of PFO may be a risk factor for severe cerebrovascular complications in the surgical management of RCC with venous involvement.
Collapse
|
2
|
Montes MC, Carbonell JP, Gómez-Mesa JE. Endovascular and medical therapy of May-Thurner syndrome: Case series and scoping literature review. JOURNAL DE MÉDECINE VASCULAIRE 2021; 46:80-89. [PMID: 33752850 DOI: 10.1016/j.jdmv.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/11/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION May-Thurner syndrome has been recognized as a cause of chronic venous insufficiency and a trigger for venous thromboembolism. There is no consensus about the definition, diagnosis, and therapeutic approach. We are aiming to describe its characteristics and a scoping literature review. METHODS A retrospective review of patients with May-Thurner syndrome from March 2010 to May 2018 and scoping literature review were made. RESULTS Seven patients were identified. All patients were female with a median age of 36 (20-60) years. The median time from the first symptom to diagnosis was 3.41 (0.01-9) years. The primary clinical presentation was post-thrombotic syndrome (4 patients). Six patients had at least one risk factor for deep venous thrombosis. All patients underwent angioplasty with stent; patients with acute deep venous thrombosis, furthermore mechanic thrombectomy with or without catheter-directed thrombolysis were done. There were three complications (one patient, lymphedema, and two venous stent thrombosis). Scoping review results were descriptively summarized. CONCLUSION May-Thurner syndrome has a varied spectrum of clinical presentation, and clinical awareness is paramount for diagnosis. Its principal complication is the post-thrombotic syndrome, which is associated with high morbidity. There is no consensus on the antithrombotic treatment approach.
Collapse
Affiliation(s)
- M C Montes
- Internal Medicine Department, Cardiology Service, Hospital Fundación Valle del Lili, Cali, CO, Colombia
| | - J P Carbonell
- Surgery Department, Vascular Surgery Service, Hospital Fundación Valle del Lili, Cali, CO, Colombia
| | - J E Gómez-Mesa
- Surgery Department, Vascular Surgery Service, Hospital Fundación Valle del Lili, Cali, CO, Colombia.
| |
Collapse
|
3
|
Zietz A, Sutter R, De Marchis GM. Deep Vein Thrombosis and Pulmonary Embolism Among Patients With a Cryptogenic Stroke Linked to Patent Foramen Ovale-A Review of the Literature. Front Neurol 2020; 11:336. [PMID: 32431661 PMCID: PMC7214694 DOI: 10.3389/fneur.2020.00336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/07/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Venous thromboembolism (VTE) can occur simultaneously with a cryptogenic stroke (CS) linked to patent foramen ovale (PFO), given paradox thromboembolism as potential stroke cause. However, little is known on the frequency of concomitant VTE and CS. We aimed to review the literature on the frequency of VTE in patients with CS linked to PFO (primary aim) and of ischemic stroke (IS) among patients with pulmonary embolism (PE) (secondary aim). Methods: We performed a Medline search for cohort studies, written in English, with the following characteristics: (a) enrolling patients hospitalized for an acute ischemic stroke undergoing a work-up for deep venous thrombosis (DVT) and/or PE. To be included in this review, a study had to have at least a subgroup of patients with PFO; (b) the time interval between the index stroke and the work-up had to be within 40 days and the studies had to differentiate between DVT and PE. For the secondary aim, studies had to include patients with acute PE, known PFO-status and routine brain imaging on admission or within 1 year. Results: We found eight studies reporting on the frequency of VTE after an acute CS linked to PFO. Concerning DVT, the reported frequency ranged between 7 and 27%; concerning PE, it lied between 4.4 and 37%. Six studies assessed the frequency of ischemic brain lesions among patients with an acute PE. In all studies, the presence of PFO was associated with ischemic brain lesions, both at baseline and follow-up. Conclusion: VTE can be detected in patients with CS linked to PFO. While –based on the presented literature–routine screening for VTE in patients with CS linked to PFO does not appear justified, history taking, and clinical exam should consider concomitant VTE. Whenever clinically suspected, the threshold to trigger ancillary testing for VTE should be low. Among patients with an acute PE and PFO, vigilance for new neurologic deficits should be increased, with a low threshold for brain imaging.
Collapse
Affiliation(s)
- Annaelle Zietz
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Raoul Sutter
- Department of Intensive Care, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| |
Collapse
|
4
|
Li S, Zhang J, Liu P, Wei R, Yuan H, Ke Q. Clinical Reasoning: A 43-year-old woman with right limb weakness. Neurology 2019; 88:e103-e107. [PMID: 28320927 DOI: 10.1212/wnl.0000000000003743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Siying Li
- From the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases (S.L.) and Department of Neurology (P.L., R.W., H.Y., Q.K.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; and the Department of Neurology (J.Z.), The Sixth Hospital of Ningbo, China. S.L. is also currently with the Department of Infectious Diseases, Hangzhou First People's Hospital, Hangzhou, China
| | - Jingjing Zhang
- From the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases (S.L.) and Department of Neurology (P.L., R.W., H.Y., Q.K.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; and the Department of Neurology (J.Z.), The Sixth Hospital of Ningbo, China. S.L. is also currently with the Department of Infectious Diseases, Hangzhou First People's Hospital, Hangzhou, China
| | - Ping Liu
- From the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases (S.L.) and Department of Neurology (P.L., R.W., H.Y., Q.K.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; and the Department of Neurology (J.Z.), The Sixth Hospital of Ningbo, China. S.L. is also currently with the Department of Infectious Diseases, Hangzhou First People's Hospital, Hangzhou, China
| | - Ruili Wei
- From the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases (S.L.) and Department of Neurology (P.L., R.W., H.Y., Q.K.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; and the Department of Neurology (J.Z.), The Sixth Hospital of Ningbo, China. S.L. is also currently with the Department of Infectious Diseases, Hangzhou First People's Hospital, Hangzhou, China
| | - Huaiwu Yuan
- From the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases (S.L.) and Department of Neurology (P.L., R.W., H.Y., Q.K.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; and the Department of Neurology (J.Z.), The Sixth Hospital of Ningbo, China. S.L. is also currently with the Department of Infectious Diseases, Hangzhou First People's Hospital, Hangzhou, China
| | - Qing Ke
- From the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases (S.L.) and Department of Neurology (P.L., R.W., H.Y., Q.K.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; and the Department of Neurology (J.Z.), The Sixth Hospital of Ningbo, China. S.L. is also currently with the Department of Infectious Diseases, Hangzhou First People's Hospital, Hangzhou, China.
| |
Collapse
|
5
|
Messerli FH, Rimoldi SF, Scherrer U, Meier B. Economy Class Syndrome, Patent Foramen Ovale and Stroke. Am J Cardiol 2017; 120:e29. [PMID: 27567137 DOI: 10.1016/j.amjcard.2016.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
|
6
|
Adams SK, Sinyangwe I. Acute iliofemoral DVT in the presence of May-Thurner syndrome. Nursing 2017; 47:32-38. [PMID: 28181918 DOI: 10.1097/01.nurse.0000512873.60892.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Susan K Adams
- At Christiana Hospital of Christiana Care Health System in Newark, Del., Susan K. Adams is a staff RN in Heart and Vascular Intervention and also a resource instructor in the Simulation Resource Center at the University of Delaware. Inga Y. Sinyangwe is Staff Development Specialist-Perioperative Services at Christiana Care Health System in Newark, Del
| | | |
Collapse
|