Belopasova A V, Dobrynina L A, Kalashnikova L A, Chechetkin A O, Karshieva A R, Abugov S A, Mardanyan G V, Puretsky M B, Shteklein A B
Research Center of Neurology, Moscow, Russia.
Petrovsky National Research Center of Surgery, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2020;120(9):107-113. doi: 10.17116/jnevro2020120091107.
Paradoxical embolism is one of the mechanisms of ischemic stroke in patients younger than 45 years of age, due to opening between the right and left chambers of the heart through a patent foramen ovale, an atrial or ventricular septal defect, pulmonary arteriovenous malformations (PAVMs), etc. The PAVMs are structurally abnormal vessels that provide direct capillary-free communication between the pulmonary and systemic circulations, and hence an anatomic "right-to-left" shunt. Most pulmonary malformations are congenital and associated with hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease). This publication highlights the issues of pathogenesis, clinical presentation, diagnosis and treatment of this pathology, and also describes a clinical case in which multiple PAVMs caused repeated ischemic strokes.
反常栓塞是45岁以下患者缺血性卒中的机制之一,其原因是通过卵圆孔未闭、房间隔或室间隔缺损、肺动静脉畸形(PAVM)等导致心脏左右腔室之间出现通道。肺动静脉畸形是结构异常的血管,可在肺循环和体循环之间提供直接的无毛细血管交通,从而形成解剖学上的“右向左”分流。大多数肺畸形是先天性的,与遗传性出血性毛细血管扩张症(伦迪-奥斯勒-韦伯病)相关。本出版物重点介绍了这种病理的发病机制、临床表现、诊断和治疗问题,还描述了一个临床病例,其中多发性肺动静脉畸形导致反复缺血性卒中。