Thrombolytic Therapy for Ischemic Stroke Secondary to Paradoxical Embolism in Pregnancy: A Case Report and Literature Review
INTRODUCTION: Thrombolysis for acute ischemic stroke has been rarely administrated during pregnancy. Paradoxical embolism through a patent foramen ovale (PFO) or pulmonary arteriovenous malformation (AVM) is an identified risk factor for ischemic stroke.
CASE REPORT: We report a 24-year-old woman at 11 weeks gestation who developed a sudden onset of dysarthria, hemiparesis, and hemisensory loss. She was diagnosed as having an ischemic stroke in the left middle cerebral artery (MCA) territory. She was treated with intra-arterial recombinant tissue plasminogen activator with subsequent resolution of her neurological deficits. Further workup revealed the presence of a PFO with a large right-to-left shunt. After being put on antithrombotic therapy, she presented again at 13 gestational weeks with a new ischemic infarction in the vertebrobasilar territory. Her PFO was closed percutaneously under ultrasonic guidance but the right-to-left shunt persisted. After a normal delivery, she was found to have a large pulmonary AVM which was successfully resected without complication.
CONCLUSIONS: This report describes the successful usage of intra-arterial tissue plasminogen activator for acute ischemic stroke during early pregnancy. In patients with presumed paradoxical embolism, careful attention should be paid to rule out a coexistence of PFO and pulmonary AVM.
Published In/Presented At
Li, Y., Margraf, J., Kluck, B., Jenny, D., & Castaldo, J. (2012). Thrombolytic therapy for ischemic stroke secondary to paradoxical embolism in pregnancy: a case report and literature review. The Neurologist, 18(1), 44-48. doi:10.1097/NRL.0b013e31823d7af0
Medical Sciences | Medical Specialties | Medicine and Health Sciences | Neurology | Obstetrics and Gynecology
Department of Medicine, Department of Medicine Faculty