Pulmonary embolism associated with acute stroke.
OBJECTIVE
To describe the circumstances surrounding pulmonary embolism associated with stroke, the prophylactic measures, and the outcome in affected patients.


METHODS
We studied pulmonary embolism in patients with acute stroke at Mayo Clinic Rochester during a 2-decade period. Medical records of 30 patients with pulmonary embolus after stroke were reviewed. Pulmonary embolus was diagnosed on the basis of pulmonary angiograms, high-or intermediate-probability ventilation-perfusion scans, or autopsy findings.


RESULTS
Sudden death occurred in 15 of 30 patients (50%) with pulmonary embolism. In the other 15 patients, pleuritic pain or dyspnea was a major initial symptom. Pulmonary embolism occurred from day 3 to day 120 (median time, day 20) after the ictus. Prophylaxis against deep venous thrombosis was noted in only 4 of 30 patients. Pulmonary embolism was associated with deep venous thrombosis diagnosed clinically or at autopsy in 11 patients, invariably in the paralyzed leg.


CONCLUSIONS
Pulmonary embolism after ischemic or hemorrhagic stroke may defy antemortem diagnosis in half of the affected patients. Pulmonary embolism in patients with acute stroke can be a cause of early mortality (during the first month after the ictus).
Wijdicks
E F
EF
Department of Neurology, Mayo Clinic Rochester, MN 55905, USA.
Scott
J P
JP
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000401:mortality*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D013924:Thrombophlebitis / Q000150:complications* / Q000209:etiology / Q000401:mortality; D013997:Time Factors