1
|
Imam Y, Al-salahat A, Aljurdi S, Mahfoud Z, Reyes CZ, Akhtar N, Abunaib M, Al-Orphaly M, Kim SW, Khodair R, Thekkumpurath T, Abumustafa R, Al-Motawa A, Sameer S, Elsetouhy A, Own A, Kamran S. Stroke in airplane passengers: A study from a large international Hub. J Stroke Cerebrovasc Dis 2022; 31:106452. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/12/2022] [Indexed: 11/27/2022] Open
|
2
|
Desai PV, Krepostman N, Collins M, De Sirkar S, Hinkleman A, Walsh K, Fareed J, Darki A. Neurological Complications of Pulmonary Embolism: a Literature Review. Curr Neurol Neurosci Rep 2021; 21:59. [PMID: 34669060 PMCID: PMC8526526 DOI: 10.1007/s11910-021-01145-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW The present review discusses in-depth about neurological complications following acute venous thromboembolism (VTE). RECENT FINDINGS Intracranial hemorrhage, acute ischemic cerebrovascular events, and VTE in brain tumors are described as central nervous system (CNS) complications of PE, while peripheral neuropathy and neuropathic pain are reported as peripheral nervous system (PNS) sequelae of PE. Syncope and seizure are illustrated as atypical neurological presentations of PE. Mounting evidence suggests higher risk of venous thromboembolism (VTE) in patients with neurological diseases, but data on reverse, i.e., neurological sequelae following VTE, is underexplored. The present review is an attempt to explore some of the latter issues categorized into CNS, PNS, and atypical complications following VTE.
Collapse
Affiliation(s)
- Parth V Desai
- Department of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Nicolas Krepostman
- Departmet of Internal Medicine, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Matthew Collins
- Departmet of Internal Medicine, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Sovik De Sirkar
- Departmet of Internal Medicine, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Alexa Hinkleman
- Departmet of Internal Medicine, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Kevin Walsh
- Departmet of Internal Medicine, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine and Department of Pharmacology and Neuroscience, Health Science Division, Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, Loyola University, Maywood, IL, 60153, USA
| | - Amir Darki
- Department of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, 60153, USA.
| |
Collapse
|
3
|
Saleh Velez FG, Ortiz Garcia JG. Management dilemmas in acute ischemic stroke and concomitant acute pulmonary embolism: Case series and literature review. eNeurologicalSci 2021; 23:100341. [PMID: 33997324 PMCID: PMC8102755 DOI: 10.1016/j.ensci.2021.100341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Pulmonary embolism (PE) and acute ischemic stroke (AIS) are common disorders with high morbidity and mortality, rarely presenting simultaneously. There is a paucity of data regarding the management of this uncommon presentation. The treatment of these two entities is complex in the acute phase due to the concomitant need for thrombolysis in AIS and anticoagulation for PE. METHODS We retrospectively reviewed confirmed ischemic stroke cases to identify patients presented with simultaneous PE from June 2018 to May 2019. Additionally, a literature review was performed. Two reviewers assessed the manuscripts' quality, and relevant data regarding clinical course and management was extracted. RESULTS We reviewed 439 patient charts, identifying two cases of concomitant AIS and PE. Additionally, twelve articles (n = 15 subjects) fulfilled our literature review criteria for a total of 17 cases, including ours. Intravenous anticoagulation (70.5%) was the most frequent intervention targeting both disorders. Therapies such as intravenous thrombolysis (23.53% (n = 4)) and mechanical thrombectomy (23.53% (n = 4)) were specific in AIS. Catheter-directed thrombolysis (5.88%) was used for PE. Clinical outcomes were favorable (asymptomatic or mild disable symptoms) in 47.05% (N = 8) of patients, while 41.17% had poor outcomes (severe disable symptoms or death). CONCLUSIONS AIS and PE stand for a challenge when they present simultaneously. The evaluation of risks and benefits of therapies such as intravenous thrombolysis, mechanical thrombectomy, and catheter-directed-thrombolysis in the clinical context is essential. According to our review, the ischemic stroke burden guides systemic anticoagulation decisions over interventional procedures when the hemodynamic status remains unaffected.
Collapse
Affiliation(s)
- Faddi G. Saleh Velez
- Department of Neurology, University of Chicago, Chicago, IL, United States of America
| | - Jorge G. Ortiz Garcia
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| |
Collapse
|
4
|
Schneck MJ. Neurologic complications of venous thromboembolism. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:261-267. [PMID: 33632445 DOI: 10.1016/b978-0-12-819814-8.00017-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Patients with neurologic disease are at high risk of venous thromboembolism (VTE). The converse risk of neurological complications in concert or following peripheral VTE is rarely considered. The major neurologic complication following pulmonary embolism or peripheral VTE is intracranial hemorrhage that occurs following anticoagulation therapy for VTE. Ischemic stroke may occur concomitantly with VTE. VT occurrence may also be a marker for a future increased risk of stroke. Peripheral neuropathy may occur or neuropathic pain may occur as a result of thrombophlebitis following deep venous thrombosis. Other sequelae of VTE are somewhat theoretical including the discovery of central nervous system malignancies after incident VTE.
Collapse
Affiliation(s)
- Michael J Schneck
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, United States.
| |
Collapse
|
5
|
Onwochei-Ashei M, McGee WT. A Rare Case of Paradoxical Embolization During Thrombolysis for Pulmonary Embolus. Neurocrit Care 2020; 30:484-486. [PMID: 30276613 DOI: 10.1007/s12028-018-0615-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Mitchell Onwochei-Ashei
- Department of Critical Care Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA.
| | - William T McGee
- Department of Critical Care Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA
| |
Collapse
|
6
|
Lio KU, Kumaran M, Rali P. Patent foramen ovale: Connecting dots from massive pulmonary embolism to acute ischemic stroke. Lung India 2019; 36:564-566. [PMID: 31670312 PMCID: PMC6852229 DOI: 10.4103/lungindia.lungindia_276_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Ka U Lio
- Medical Student, MBBS, Shanghai Jiao Tong University School of Medicine, Shanghai, China. E-mail:
| | - Maruti Kumaran
- Department of Radiology, Temple University Hospital, Philadelphia, PA, USA
| | - Parth Rali
- Division of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, USA
| |
Collapse
|
7
|
Prominent cerebral veins on susceptibility-weighted imaging (SWI) in pulmonary embolism. Eur Radiol 2016; 27:3004-3012. [DOI: 10.1007/s00330-016-4606-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 09/03/2016] [Accepted: 09/07/2016] [Indexed: 01/28/2023]
|
8
|
Humaidan H, Yassi N, Weir L, Davis SM, Meretoja A. Airplane stroke syndrome. J Clin Neurosci 2016; 29:77-80. [PMID: 26898578 DOI: 10.1016/j.jocn.2015.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 12/27/2015] [Indexed: 11/24/2022]
Abstract
Only 37 cases of stroke during or soon after long-haul flights have been published to our knowledge. In this retrospective observational study, we searched the Royal Melbourne Hospital prospective stroke database and all discharge summaries from 1 September 2003 to 30 September 2014 for flight-related strokes, defined as patients presenting with stroke within 14days of air travel. We hypothesised that a patent foramen ovale (PFO) is an important, but not the only mechanism, of flight-related stroke. We describe the patient, stroke, and flight characteristics. Over the study period, 131 million passengers arrived at Melbourne airport. Our centre admitted 5727 stroke patients, of whom 42 (0.73%) had flight-related strokes. Flight-related stroke patients were younger (median age 65 versus 73, p<0.001), had similar stroke severity, and received intravenous thrombolysis more often than non-flight-related stroke patients. Seven patients had flight-related intracerebral haemorrhage. The aetiology of the ischaemic strokes was cardioembolic in 14/35 (40%), including seven patients with confirmed PFO, one with atrial septal defect, four with atrial fibrillation, one with endocarditis, and one with aortic arch atheroma. Paradoxical embolism was confirmed in six patients. Stroke related to air travel is a rare occurrence, less than one in a million. Although 20% of patients had a PFO, distribution of stroke aetiologies was diverse and was not limited to PFO and paradoxical embolism.
Collapse
Affiliation(s)
- Hani Humaidan
- Neuroscience Department, Salmaniya Medical Complex Ministry of Health, Bahrain; Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia
| | - Nawaf Yassi
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia
| | - Louise Weir
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia
| | - Stephen M Davis
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia
| | - Atte Meretoja
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia.
| |
Collapse
|
9
|
Condliffe R, Elliot CA, Hughes RJ, Hurdman J, Maclean RM, Sabroe I, van Veen JJ, Kiely DG. Management dilemmas in acute pulmonary embolism. Thorax 2013; 69:174-80. [PMID: 24343784 PMCID: PMC3913120 DOI: 10.1136/thoraxjnl-2013-204667] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Physicians treating acute pulmonary embolism (PE) are faced with difficult management decisions while specific guidance from recent guidelines may be absent. Methods Fourteen clinical dilemmas were identified by physicians and haematologists with specific interests in acute and chronic PE. Current evidence was reviewed and a practical approach suggested. Results Management dilemmas discussed include: sub-massive PE, PE following recent stroke or surgery, thrombolysis dosing and use in cardiac arrest, surgical or catheter-based therapy, failure to respond to initial thrombolysis, PE in pregnancy, right atrial thrombus, role of caval filter insertion, incidental and sub-segmental PE, differentiating acute from chronic PE, early discharge and novel oral anticoagulants. Conclusion The suggested approaches are based on a review of the available evidence and guidelines and on our clinical experience. Management in an individual patient requires clinical assessment of risks and benefits and also depends on local availability of therapeutic interventions.
Collapse
Affiliation(s)
- Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, , Sheffield, UK
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Pilato F, Calandrelli R, Profice P, Della Marca G, Broccolini A, Bello G, Bocci MG, Distefano M, Colosimo C, Rossini PM. Pulmonary embolism in a stroke patient after systemic thrombolysis: clinical decisions and literature review. J Stroke Cerebrovasc Dis 2013; 22:e667-70. [PMID: 23849749 DOI: 10.1016/j.jstrokecerebrovasdis.2013.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 04/15/2013] [Accepted: 06/07/2013] [Indexed: 11/26/2022] Open
Abstract
Pulmonary embolism can be a catastrophic event that can result in early death or serious hemodynamic dysfunction. The dehydration, immobility, and infections occurring in acute stroke patients puts these patients at risk of developing deep vein thrombosis and pulmonary embolism. Recombinant tissue-type plasminogen activator (rt-PA) is the established therapy for acute ischemic stroke, and its prompt administration results in a better outcome in stroke patients. We describe a 73-year-old man who arrived at the emergency room within 2 hours of acute onset of left hemiparesis who was treated with rt-PA and suffered a pulmonary embolism 3 days after acute stroke therapy. rt-PA is also a current therapy for pulmonary embolism, but an ischemic stroke in the previous 3 months is an absolute contraindication to thrombolysis because of the high risk of intracranial hemorrhage. We discuss clinical and therapeutic decisions and review the current literature.
Collapse
Affiliation(s)
- Fabio Pilato
- Stroke Unit, Institute of Neurology, Università Cattolica, Rome, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Omar H, Huang C, Miller J, Mangar D, Kabemba A, Camporesi E. Simultaneous pulmonary embolism and cerebrovascular stroke. Herz 2013; 38:884-6. [DOI: 10.1007/s00059-013-3782-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 02/12/2013] [Indexed: 11/25/2022]
|
12
|
Delgado MG, Mauri G, Vega J. Massive pulmonary thromboembolism after intravenous stroke thrombolysis. BMJ Case Rep 2012; 2012:bcr.10.2011.5008. [PMID: 22605816 DOI: 10.1136/bcr.10.2011.5008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors present a 76-year-old female with high blood pressure and hypercholesterolaemia as cerebrovascular risk factors, who received intravenous thrombolysis for an ischaemic stroke with a progressive neurological improvement. She was asymptomatic at 48 h and she was transferred to the neurology department where antithrombotic treatment was initiated. She began to sit the following day when she suffered a massive pulmonary embolism (PE). Cardiological study showed patent foramen oval persistence and the presence of an atrial septa aneurysm, and paroxysmal atrial fibrillation. The delay of the onset of the antithrombotic treatment could have been determinant for the massive PE. Thromboembolic complications may be seen after intravenous thrombolysis for ischaemic stroke. An accurate treatment is needed in order to avoid potentially threatening complications such as massive PE.
Collapse
Affiliation(s)
- Montserrat G Delgado
- Neurology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | | | | |
Collapse
|
13
|
Massive pulmonary thromboembolism and stroke. Case Rep Med 2011; 2011:398571. [PMID: 21966293 PMCID: PMC3182343 DOI: 10.1155/2011/398571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 06/22/2011] [Indexed: 11/17/2022] Open
Abstract
A 38-year-old HIV-positive female, recently started on antiretroviral therapy, presented in extremis. She had features suggestive of an HIV-associated cardiomyopathy complicated by the following problems: a four-day-old stroke, extensive deep venous thrombosis, and massive pulmonary embolism. She received intravenous streptokinase with rapid improvement, both haemodynamically and, unexpectedly, neurologically. Our case illustrates that a positive outcome is potentially possible where the two conditions coincide.
Collapse
|
14
|
Ruiz-Bailén M, Ramos-Cuadra JA, Machado-Casas J, Rucabado-Aguilar L. Successful administration of alteplase in a venous thromboembolism crossing through a patent foramen ovale. Interact Cardiovasc Thorac Surg 2009; 9:712-3. [PMID: 19592415 DOI: 10.1510/icvts.2009.209064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe a case report observed via an echocardiography of a venous thromboembolism (VTE) that crosses through the patent foramen ovale to the left atrium and is successfully treated with alteplase. This is a case report of a tertiary care hospital without cardiac surgery facilities. An 81-year-old female seeking medical attention for dyspnoea, arriving at hospital with hypoxaemia, hypotension and prerenal failure. A computed tomographic (CT) pulmonary angiography was carried out, revealing a VTE. A transesophageal echocardiography (TEE) was carried out, exposing emboli in the right cavities, said thrombus crossing through the patent foramen ovale to the left atrium. A systemic thrombolysis is carried out using alteplase which improves the patient's condition and results in the disappearance of thrombotic images in the various cardiac cavities. The evolution is positive and there is no evidence of embolic or haemorrhagic complications. When a paradoxical embolism is present, in the context of a serious VTE, carrying out thrombolysis could be a therapeutic option.
Collapse
Affiliation(s)
- Manuel Ruiz-Bailén
- Department of Critical Care and Emergency, Intensive Care Unit, Hospital Universitario Médico-Quirúrgico del Complejo Hospitalario de Jaén, University of Jaén, Spain.
| | | | | | | |
Collapse
|