Paradoxical embolism with the development of ischemic stroke on the background of pulmonary embolism: comparative analysis of two clinical cases

Abstract

The development of a neurological deficit clinic in patients with pulmonary embolism (PE) requires a diagnostic search aimed at excluding the phenomenon of paradoxical embolism in the form of transcranial dopplerography (TCDG) with a bubble test , and to clarify the features of intracardiac hemodynamics – transesophageal echocardiography (TEE). Material and methods . The article presents two clinical examples of the development of PE in the form of embolic ischemic stroke (IS) against the background of deep vein thrombosis of the lower extremities , PE, patent foramen ovale (PFO) in combination with an atrial septal aneurysm . Results and discussion . In the first case , the right-left shunt was confirmed by TKDG with a bubble test , in the second example , during routine transthoracic echocardiography , a ribbon thrombus prolapsing through the PFO was visualized . In our opinion , PE is a possible mechanism of IS in patients with venous thromboembolic events . Consequently , it is necessary to plan a “ bubble test ” for verifying the cause of a stroke . Conclusions . The management of patients with PE and IS was individual and required a team approach , including the use of thrombolytic therapy , the selection of an anticoagulant therapy regimen , choice of conservative / invasive tactics for the treatment of patients .