title: A patient with multiple paradoxical emboli.
abstract: We present a case report of simultaneous pulmonary emboli and paradoxical embolism to the cerebellum causing a stroke and severe ischemia to the left leg. This patient had risk factors for thromboembolic events that included autoimmune disease, cancer, and recent pelvic surgery. The presence of a perforate foramen ovale was suspected on his initial presentation and confirmed with echocardiography. For acute leg ischemia, this patient underwent emergent left common femoral embolectomy. The potential benefit of immediate anticoagulation had to be weighed against the risk of hemorrhagic transformation of his cerebellar stroke with possible compression of the fourth ventricle. In the end, full anticoagulation was delayed with interval placement of a retrievable inferior vena cava filter. This case illustrates the challenges faced in treating a patient with multiple paradoxical emboli.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, UConn Health, Farmington, Conn.
authors.forename: Mofei
authors.initials: M
authors.lastname: Liu
authors.affiliation: Department of Surgery, Division of Vascular Surgery, UConn Health, Farmington, Conn. Electronic address: jmenzoian@uchc.edu.
authors.forename: James O
authors.initials: JO
authors.lastname: Menzoian
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D002531:Cerebellum / Q000098:blood supply*; D002533:Cerebral Angiography / Q000379:methods; D003131:Combined Modality Therapy; D017128:Embolectomy; D019320:Embolism, Paradoxical / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016306:Vena Cava Filters
chemical_list: D000925:Anticoagulants