6533b7d2fe1ef96bd125ed3a

RESEARCH PRODUCT

Paradoxical embolism through a patent foramen ovale from central venous catheter thrombosis: A potential cause of stroke

Lorenzo Di LiberatoMaria Vittoria De AngelisVincenzo Di StefanoMarco OnofrjMaria Di Fulvio

subject

Adultmedicine.medical_specialtyArterial embolismCardioembolismmedicine.medical_treatmentEmbolismForamen Ovale Patent03 medical and health sciences0302 clinical medicineParadoxical embolismEmbolusUpper Extremity Deep Vein ThrombosisInternal medicinemedicineHumanscardiovascular diseases030212 general & internal medicineThrombusStrokebusiness.industryCardiac shuntmedicine.diseasePatent foramen ovaleStrokeNeurologyPatent foramen ovaleCardiologySettore MED/26 - NeurologiaFemaleNeurology (clinical)businessCentral venous catheterEchocardiography Transesophageal030217 neurology & neurosurgeryCentral venous catheterEmbolism Paradoxical

description

Paradoxical embolism refers to a potential condition in which an embolus arising from a venous source crosses into the systemic circulation through a right-to-left cardiac shunt causing an arterial embolism. A 39-year-old woman carrier of a central venous catheter (CVC) without evident risk factors for stroke, developed an acute right homonymous hemianopia during hemodialysis. On neuroimaging, an infarct in the territory of the left posterior cerebral artery was demonstrated. Transesophageal echocardiography revealed a patent foramen ovale (PFO) and a large fluctuating thrombus in the right atrium on the tip of the CVC, thus allowing a diagnosis of ischemic stroke from paradoxical embolism. Oral anticoagulation therapy was started and the PFO was closed. This case emphasizes the potential risk of paradoxical embolism in patients with CVCs and PFO. This condition should be prevented and identified in patients with specific risk factors, such as long-term catheterization and hemodialysis.

yearjournalcountryeditionlanguage
2020-07-15Journal of the Neurological Sciences
https://doi.org/10.1016/j.jns.2020.116820