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Pulmonary Embolism in Ischemic Stroke

  • Prasanna Venkatesan Eswaradass (a1), Sadanand Dey (a1), Dilip Singh (a1) and Michael D. Hill (a1) (a2) (a3) (a4) (a5)

Abstract

Silent pulmonary embolism (PE) may be associated with acute ischemic stroke (AIS). We identified 10 patients from 3,132 unique patients (3,431 CT scans). We retrospectively examined CT angiogram of patients with AIS to determine the frequency of concurrent PE in AIS. The period prevalence of PE was 0.32. Seven patients had concurrent PE, whereas three had PE diagnosed 2 days after their AIS presentation. We suspected paradoxical embolism via patent foramen ovale as the cause of stroke in three patients and thrombophilia in four patients. Seven patients had poor outcome including four deaths. CT angiogram stroke protocol images from aortic arch to vertex allows visualization of upper pulmonary arteries and PE detection in AIS.

Cas d’embolie pulmonaire liés à des accidents ischémiques cérébraux. Des cas d’embolie pulmonaire (EP) silencieuse peuvent être associés à des accidents ischémiques cérébraux (AIC) aigus. À cet effet, nous avons repéré 10 patients sur un total de 3 132 patients, lesquels avaient passé un total de 3 431 examens de tomodensitométrie. De façon rétrospective, nous avons passé en revue les examens d’angiographie de patients ayant été victimes d’AIC afin de déterminer la fréquence d’EP concomitantes. La période de prévalence des EP était de 0,32. On a pu observer sept patients victimes d’EP concomitantes alors qu’on a diagnostiqué chez trois d’entre eux des EP survenant deux jours après que leurs AIC se sont manifestés. Nous faisons l’hypothèse qu’une embolie paradoxale, par l’entremise du foramen ovale perméable (FOP), est la cause d’un AIC chez trois patients et de la thrombophilie chez quatre autres. Sept patients ont donné à voir une évolution défavorable de leur état de santé, ce qui inclut quatre décès. Enfin, l’analyse menée à la suite d’examens d’angiographie de la crosse aortique au vertex, le tout en vertu d’un protocole de calibration des images, a permis de visualiser les artères pulmonaires supérieures et de détecter des cas d’EP associés à des AIC.

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Copyright

Corresponding author

Correspondence to: Michael D. Hill, Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Room 2939, Calgary, AB, Canada T2N 4N1. Email: michael.hill@ucalgary.ca

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