title: A case of pregnancy with a history of paradoxical brain embolism.
abstract: Brain embolisms in younger persons are rare but are often caused by a paradoxical embolism, the embolic entry of a venous thrombus into the systemic circulation through a right-to-left shunt. A 27-year-old pregnant woman presented with hemiplegia that had been treated with an antiplatelet agent since the occurrence of a paradoxical brain embolism via the pulmonary arteriovenous fistula. A tendency of hypercoagulation is generally observed during pregnancy, so a patient with this condition has a strong risk factor for venous thromboembolism during pregnancy and even more so for arterial thromboembolism under the intense strain of labor, which is much stronger than that of the Valsalva maneuver. This case had been controlled well with an antiplatelet agent and an anticoagulant while the levels of coagulation and fibrinolytic factors were monitored and was followed by a successful pregnancy outcome.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-8666 Japan. tadachi@obgy.twmu.ac.jp
authors.forename: Tomoko
authors.initials: T
authors.lastname: Adachi
authors.forename: Kazunari
authors.initials: K
authors.lastname: Hashiguchi
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ohta
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001164:Arteriovenous Fistula / Q000097:blood / Q000150:complications / Q000188:drug therapy; D001777:Blood Coagulation; D019320:Embolism, Paradoxical / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D007231:Infant, Newborn; D020766:Intracranial Embolism / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000097:blood / Q000188:drug therapy*; D011256:Pregnancy Outcome; D011651:Pulmonary Artery; D013923:Thromboembolism / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors