[50-year-old patient with dyspnea, dizziness, palpitations and brief sensory aphasia].
After a syncope, a 50 years old female patient was administered with an incomplete central facial paralysis on the left side combined with dyspnea, tachycardia, and hypotension as well as a systolic nurmur over the tricuspid valve. One week before, a vein stripping of the left long saphenous vein had been undertaken. By doppler-ultrasound, a thrombosis of the left tibial veins could be found as the cause of the pulmonary embolism. Additionally, the echocardiogram showed a relative tricuspid insufficiency and a floating atrial septum combined with an enlarged right atrium as an expression of the pulmonary hypertension. The incomplete central facial paralysis must be due to a paradox embolism in the cerebrovascular circulation as a result of an open foramen ovale. Under a therapy with high-dose heparin, all findings receded totally within one week.
Hager
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Klinik für Innere Medizin, Krankenhaus Berlin-Weissenesee, Akademisches Lehrkrankenhaus der Humboldt-Universität zu Berlin.
Koch
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D001041:Aphasia, Wernicke / Q000209:etiology*; D003937:Diagnosis, Differential; D004244:Dizziness / Q000209:etiology*; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D006339:Heart Rate; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis; D002542:Intracranial Embolism and Thrombosis / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis*; D013924:Thrombophlebitis / Q000150:complications / Q000175:diagnosis
50jährige Patientin mit Dyspnoe, Schwindel, Palpitationen und kurzzeitiger sensorischer Aphasie.