Pulmonary thromboembolism in patients with stroke: the results of the clinical-anatomic analysis

Abstract

Pulmonary embolism is a major cause of mortality in stroke patients and up to 50% of premature deaths in hospitalized patients. The non-specific clinical picture causes diagnostic errors and severely limits the initiation of treatment in atimely manner.The aim of the study was to analyze missed cases of pulmonary embolism in stroke patients treated within the institutional cohort by analyzing the results of morpho pathological examinations. Materials and methods: Retrospective study. Pulmonary thromboembolism was studied as a major cause of death in patients with stroke, hospitalized in the Diomid Gherman Institute of Neurology and Neurosurgery during 2017-2020. 13 patients with a morpho pathologically confirmed diagnosis were included in the study. Results: The study included 5 men (38.5%) and 8 women (61.5%) with an average age of 65±5.2 years. In all patients the diagnosis of stroke was confirmed by CT: ischemic stroke was established in 6 patients (46.8%), hemorrhagic stroke in 4 patients (30.1%), of which 1 patient underwent surgery (7.7%), stroke with hemorrhagic transformation in 3 patients (23.1%). For 11 patients (84.6%) the stroke was primary, and for 2 patients (15.4%) it was repeated. The risk factors were hypertension - 12 patients (92.3%), in 8 patients (61.5%) obesity, diabetes mellitus -5 patients (38.5%), atrial fibrillation in 5 patients (38.5%), 1 patient (7.7%) with thrombosis in other areas. The morpho pathological diagnosis established that pulmonary embolism was the cause of death in all cases, but only 2 (15.4%) patients presented specific symptoms. Conclusion. Stroke patients are at increased risk of pulmonary embolism due to bed rest, limb paralysis and predisposing risk factors, but only a small number of patients are diagnosed in a timely manner, therefore it is important for the clinician to be aware of the severity of the problem and establishing strict prophylaxis and treatment protocols.