Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India.
Department of Critical Care Medicine, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India.
Neurol India. 2021 Sep-Oct;69(5):1371-1373. doi: 10.4103/0028-3886.329553.
The management of established pulmonary thromboembolism (PTE) coexisting with acute ischemic stroke (AIS) is quite challenging. We report the case of a 52-year-old man with concurrent massive right middle cerebral artery AIS and acute PTE, who was successfully managed despite the contradictory guidelines to manage them simultaneously. The patient underwent decompression craniotomy followed by anticoagulant therapy. The current case report demonstrates that full-dose heparin, despite being relatively contraindicated in an AIS, can achieve a good outcome when given under close monitoring. The transesophageal echo with bubble contrast during the Valsalva maneuver demonstrated patent foramen ovale with a right to left shunt as a cause of AIS and PTE in this patient.
治疗同时患有急性缺血性脑卒中（AIS）和已确立的肺血栓栓塞症（PTE）的患者极具挑战性。我们报告了一例 52 岁男性同时患有大量右侧大脑中动脉 AIS 和急性 PTE 的病例，尽管同时治疗存在相互矛盾的指南，但该患者仍成功得到了治疗。该患者接受了减压开颅手术和抗凝治疗。本病例报告表明，尽管大剂量肝素在 AIS 中相对禁忌，但在密切监测下使用仍可获得良好的结果。经胸超声心动图伴瓦氏动作中的微泡造影显示卵圆孔未闭，存在右向左分流，是导致该患者发生 AIS 和 PTE 的原因。
