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Sun H, Yang Y, Yang R, Tian X, Zhao Y, Wu H, Gao Z. Paradoxical Embolism in Juveniles and Young Adults With Severe-to-Profound Sudden Sensorineural Hearing Loss. EAR, NOSE & THROAT JOURNAL 2024:1455613241250185. [PMID: 38801178 DOI: 10.1177/01455613241250185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Objective: Paradoxical embolism from right-to-left shunting is a common cause of cryptogenic stroke in the young. Circulatory ischemia of the cochlea is closely connected with severe-to-profound sudden sensorineural hearing loss. This study aimed to explore the role of paradoxical embolism in severe-to-profound sudden sensorineural hearing loss in juveniles and young adults. Methods: From August 2021 to September 2022, consecutive outpatients under 35 years of age with severe-to-profound sudden hearing loss were included in the study. Routine auditory electrophysiological testing and contrast transcranial Doppler ultrasonography (c-TCD) were conducted, and the results were retrospectively analyzed. Results: Seven patients (age: 19.4 ± 6.5 years) were enrolled, including 5 juveniles and 2 young adults. Three patients had severe deafness, and 4 patients had profound deafness. Right-to-left shunting was detected in all patients through c-TCD. Patent foramen ovale was found in 2 patients while pulmonary arteriovenous fistula was found in 1 patient through contrast transthoracic echocardiography or cardiac catheterization. No patients had precipitating factors for sudden sensorineural hearing loss, and none had abnormalities on head magnetic resonance imaging. Six patients underwent whole-exome sequencing, and no known deafness gene variant was detected. After standard treatment for 1 month, 2, 3, and 2 patients had complete, slight, and no hearing recovery, respectively. Conclusions: Paradoxical embolism is a possible cause of severe-to-profound sudden sensorineural hearing loss in juveniles and young adults. In young patients, c-TCD is an effective screening tool to detect right-to-left shunting, while contrast transthoracic echocardiography is a complementary examination to c-TCD.
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Affiliation(s)
- Huiying Sun
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuchen Yang
- Department of Neurology and Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruizhe Yang
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Tian
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Zhao
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyan Wu
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiqiang Gao
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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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.
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Affiliation(s)
- Michael J Schneck
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, United States.
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Roy S, Le H, Balogun A, Caskey E, Tessitore T, Kota R, Hejirika J, Yu S, Nguyen L, Lazo AL, Yard C, Monaghan M, Dhingra M, Modi S, Hunter K. Risk of Stroke in Patients With Patent Foramen Ovale Who Had Pulmonary Embolism. J Clin Med Res 2020; 12:190-199. [PMID: 32231756 PMCID: PMC7092756 DOI: 10.14740/jocmr4094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 01/27/2020] [Indexed: 11/29/2022] Open
Abstract
Background The presence of patent foramen ovale (PFO) alone does not increase the risk of ischemic stroke. Several prospective studies with a small number of patients have shown that the risk of ischemic stroke is higher in patients with PFO and pulmonary embolism (PE). We studied the association of ischemic stroke in the patients who had PFO with PE (PFOwiPE) and compared with the patients who had PFO without PE (PFOwoPE). Methods Electronic medical records of 154 adult patients in our internal medicine office were reviewed. Thirty-four patients had PFOwiPE and 120 had PFOwoPE. Independent t-test and Mann-Whitney U-test were used to compare the continuous variables between the two groups, while Chi-square tests were applied to compare the categorical variables between the two groups. Logistic regression was used for multivariate analysis. The dependent variable was stroke and the independent variable of interest was PFO with, or without PE. Results Mean age of patients with PFOwiPE was 54.8 years and patients with PFOwoPE was 57.8 years (P = 0.331). Mean body mass index (BMI) of the patients with PFOwiPE was significantly greater than the patients with PFOwoPE (32.5 ± 8.84 kg/m2 vs. 28.4 ± 6.99 kg/m2; P < 0.05). Mean left ventricular ejection fraction (LVEF) and red blood cell (RBC) count of patients with PFOwiPE was significantly lower than patients with PFOwoPE (LVEF 54.9 ± 13.01% vs. 59.6 ± 6.85%, P < 0.05; RBC 4.1 ± 1.203 × 106/µL vs. 4.5 ± 0.596 × 106/µL, P < 0.05). There was significantly higher association of congestive heart failure (CHF) in patients with PFOwiPE compared to patients with PFOwoPE (20.6% vs. 7.5%; P < 0.05). Association of ischemic stroke was 35.3% in patients with PFOwiPE and 39.2% in patients with PFOwoPE. The difference was not statistically significant (P = 0.682). Conclusions Association of ischemic stroke was similar in patients with PFOwiPE and patients with PFOwoPE. Association of significantly higher BMI, lower LVEF, lower RBC count, and higher frequency of CHF were associated with patients with PFOwiPE compared to the patients with PFOwoPE.
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Affiliation(s)
- Satyajeet Roy
- Department of Medicine, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ, USA
| | - Han Le
- Department of Medicine, Cooper University Health Care, Camden, NJ, USA
| | | | - Elizabeth Caskey
- Department of Medicine, Cooper University Health Care, Camden, NJ, USA
| | | | - Rasagnya Kota
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Siyuan Yu
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Long Nguyen
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | | | | | - Menaka Dhingra
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Sneha Modi
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Krystal Hunter
- Cooper Research Institute, Cooper Medical School of Rowan University, Camden, NJ, USA
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