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Cerebral paradoxical embolisation in a patient with cystic fibrosis with patent foramen ovale: a comparative review of literature
  1. Taha Ahmed1,
  2. Samra Haroon Lodhi2,
  3. Michael I Anstead3 and
  4. Adrian W Messerli4
  1. 1Internal Medicine, University of Kentucky, Lexington, Kentucky, USA
  2. 2Internal Medicine, King Edward Medical University, Lahore, Pakistan
  3. 3Adult and Pediatric Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, Kentucky, USA
  4. 4Interventional Cardiology, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, USA
  1. Correspondence to Dr Taha Ahmed; tahaahmedfairview{at}gmail.com

Abstract

A 52-year-old woman with cystic fibrosis presented to the emergency department with expressive aphasia and right-sided hemiparesis. CT scan of the brain revealed a left middle cerebral artery territory infarct. A diagnosis of cerebral paradoxical embolisation associated with patent foramen ovale and a history of deep venous thrombosis was made. The patient underwent endovascular thrombectomy and percutaneous closure of patent foramen ovale. Current literature, including five published case reports, pertaining to the subject is discussed. The unique aspects of the case are highlighted, including the particular risk of cerebral paradoxical embolisation in patients with cystic fibrosis. The result of this case report, in context to previously reported literature, suggests that clinicians should be aware of paradoxical embolisation in patients with cystic fibrosis via an intracardiac shunt, particularly with implanted vascular access devices and a history of deep venous thrombosis.

  • respiratory system
  • neuroimaging
  • stroke
  • cystic fibrosis
  • interventional cardiology

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Footnotes

  • Twitter @TahaAhmedMD

  • Contributors TA designed the study, performed the literature review, drafted the manuscript, formulated the table and reviewed the manuscript. SHL performed the literature review, contributed to the discussion and suggested pertinent modifications. MIA contributed to the case presentation and discussion, revised the manuscript critically for important intellectual content and gave final approval for the version published. AWM contributed to the case presentation and discussion, and performed critical review and supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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