Cerebral infarction following thrombolysis for massive pulmonary embolism.
A 29-year-old male developed a fatal stroke 6 h after successful thrombolysis for massive pulmonary embolism. Autopsy showed thrombus protruding through a patent foramen ovale (PFO). A strand of thrombus extended from the aortic arch into the left common carotid artery. The brain showed extensive infarction of the left fronto-parietal area. Thrombolysis caused initial disintegration of the embolism. It is likely that thrombolysis caused fragments of clot to later break lose and embolise into the cerebral circulation. We discuss the need for risk stratification in patients who present with massive pulmonary embolism and PFO.
Bracey
Tim S
TS
Anaesthetics Department, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK.
Langrish
Chris
C
Darby
Mike
M
Soar
Jasmeet
J
D000328:Adult; D001921:Brain / Q000473:pathology; D002544:Cerebral Infarction / Q000209:etiology* / Q000473:pathology; D019320:Embolism, Paradoxical / Q000209:etiology*; D017809:Fatal Outcome; D006344:Heart Septal Defects, Atrial / Q000150:complications*; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000150:complications / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*