title: Concomitant submassive pulmonary embolism and paradoxical embolic stroke after a long flight: which is the optimal treatment?
abstract: Economy class stroke syndrome consists of ischemic stroke due to paradoxical embolism through patent foramen ovale after a long flight. Few cases have been described in the literature to date. The treatment choice could be tricky. We present the case of a 65-year-old woman, admitted for submassive pulmonary embolism after a long flight, that presented a paradoxical embolic stroke through patent foramen ovale shortly after. The patient was treated with intravenous thrombolysis within 1 h of stroke onset with a definite symptoms improvement. Afterwards, intravenous unfractioned heparin was started with strict partial thromboplastin time monitoring. Cerebral computed tomography scan, obtained after 24 and 72 h, ruled out hemorrhage. Warfarin was started after 72 h. Patent foramen ovale was percutaneously closed 3 months after. In the reported case, the treatment with thrombolysis and subsequent heparin infusion was effective and safe. We discuss the rationale for this treatment in the light of literature data.
authors.affiliation: Cardiology Department, Maggiore Hospital, Bologna, Italy.
authors.forename: Pier Camillo
authors.initials: PC
authors.lastname: Pavesi
authors.forename: Chiara
authors.initials: C
authors.lastname: Pedone
authors.forename: Michela
authors.initials: M
authors.lastname: Crisci
authors.forename: Alberto
authors.initials: A
authors.lastname: Piacentini
authors.forename: Maria
authors.initials: M
authors.lastname: Fulvi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Pasquale
mesh_terms: D000368:Aged; D000401:Aircraft; D000925:Anticoagulants / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000150:complications / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology / Q000601:surgery; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D011655:Pulmonary Embolism / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D015912:Thrombolytic Therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014195:Travel; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin