Paradoxical brain embolism from thrombus associated with vena caval filter in a patient with cancer.
A 71-year-old man experienced sudden onset of hemiparesis and aphasia. He had a 4-month history of gallbladder cholangiocarcinoma, complicated with a postoperative deep-vein thrombosis (DVT) that necessitated a vena caval filter placement. Diffusion-weighted magnetic resonance imaging of the brain showed multiple hyperintense foci. Magnetic resonance spectroscopy was compatible with cerebral infarction. Abdominal computed tomography showed a thrombus in the inferior vena cava extending through the filters. A transcranial Doppler bubble study revealed the presence of a right-to-left shunt. Paradoxical cerebral embolism must be considered in patients with DVT who have new onset neurologic deficits even in the presence of a caval filter.
Ionita
Catalina
C
Department of Neurology, Buffalo General Hospital, Buffalo, New York, USA.
Giglio
Pierre
P
Isayev
Eugene
E
Alberico
Ronald
R
Pullicino
Patrick
P
D000368:Aged; D018281:Cholangiocarcinoma / Q000150:complications; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005706:Gallbladder Neoplasms / Q000150:complications; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D013923:Thromboembolism / Q000150:complications* / Q000209:etiology; D016306:Vena Cava Filters / Q000009:adverse effects*