Successful thrombolysis of a stroke with a pulmonary embolism in a young woman.
BACKGROUND
Paradoxical embolism is a rare event, accounting for < 2% of all arterial emboli. The diagnosis is often difficult, and consequences for the patient can be severe.


METHODS
We describe the case of a 35-year-old female physician who presented to our Emergency Department (ED) in severe hemodynamic compromise, with an altered level of consciousness and major expressive aphasia 1 day after undergoing a leg varicosal stripping procedure under regional anesthesia. She was successfully thrombolyzed with 0.9 mg/kg of Recombinant Tissue Plasminogen Activator (rtPA, Alteplase) and had a full recovery.


CONCLUSIONS
To our knowledge, this is the first description of a case of massive pulmonary embolism associated with a paradoxical stroke related to patent foramen ovale that was thrombolyzed for both conditions with a "neurological dose" of rtPA. Although thrombolysis was completely successful in this case, indications and contraindications should be thoroughly respected. A more conservative approach with anticoagulation, or a more aggressive approach with surgical thrombectomy, can each potentially have a place in particular cases. Intra-arterial catheter-directed thrombolysis and percutaneous embolectomy are additional options to be considered when available, especially if there are contraindications for systemic thrombolysis.
Emergency Medicine Department, Centre Hospitalier Régional de Lanaudière, St-Charles-Borromée, Québec, Canada.
Mathieu
M
Pelletier
Ronald
R
Bugeaud
Reda
R
Ibrahim
Gilles
G
Morency
Simon
S
Kouz
D000328:Adult; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D019320:Embolism, Paradoxical; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D011655:Pulmonary Embolism / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D015912:Thrombolytic Therapy / Q000379:methods*; D014057:Tomography, X-Ray Computed