Abstract
IntroductionWe report a case of a patient presenting with neuropsychiatric manifestations secondary to paradoxical embolismCase presentationUnexplained rapid onset of confusion with amnesia and minimal neurological deficits can be a manifestation of various systemic causes of which stroke, either ischemic or hemorrhagic, is one. Thorough and systematic evaluation of these patients can be highly rewarding in terms of optimizing patient outcome. We report the case of a 45-year-old woman whose initial presentation was with acute onset of confusion, memory loss with personality change and headaches. A differential diagnosis of systemic illness and cerebral pathology was entertained. She was empirically treated for neurological infection. Brain imaging revealed bilateral thalamic and cerebellar infarction. Further evaluation with an aim to define the etiology, revealed the diagnosis of Patent Foramen Ovale with paradoxical embolism. The differential diagnosis of unexplained rapid onset of confusion, amnesia with minimal motor neurological deficits and relevant appropriate investigations are discussed in this case report.ConclusionThis case highlights the importance of recognising the atypical manifestations of posterior fossa stroke. In young patients presenting with non-focal neuropsychiatric manifestations, paradoxical embolism, secondary to patent foramen ovale is a possible cause.
Highlights
We report a case of a patient presenting with neuropsychiatric manifestations secondary to paradoxical embolismCase presentation: Unexplained rapid onset of confusion with amnesia and minimal neurological deficits can be a manifestation of various systemic causes of which stroke, either ischemic or hemorrhagic, is one
In young patients presenting with non-focal neuropsychiatric manifestations, paradoxical embolism, secondary to patent foramen ovale is a possible cause
Though not as common in younger patients, unexplained rapid onset of confusion with amnesia and minimal neurological deficits can be a manifestation of various systemic causes of which stroke, either ischemic or hemorrhagic, is one
Summary
The clinical picture in our patient was neuropsychiatric manifestations without any focal deficits. The symptoms of confusion, memory impairment and personality changes pointed more towards a non-focal neurological cause. The diagnosis of posterior fossa stroke due to paradoxical embolism was made. This case highlights the importance of thorough evaluation, to rule out systemic causes, while at the same time bearing in mind that it could be an atypical presentation of stroke, especially involving the cerebellum and thalami. 5. Webster MW, Chancellor AM, Smith HJ, Swift DL, Sharpe DN, Bass NM, Glasgow GL: Patent foramen ovale in young stroke patients. 8. Serva J, Catala H, Rancurel G: Posterior cerebral artery infarction: a study of 76 cases. In Where is the lesion? Blackwell science limited; 1996:123-124
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