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An overlooked cause in a patient with recurrent ischemic stroke: A case report.

Abstract The majority of ischemic strokes are due to cardioembolism, large vessel atherothromboembolism, small vessel occlusive disease, or other unusual mechanisms. In most clinical settings, many strokes without a well-defined etiology requires a thorough diagnostic evaluation, otherwise the underlying cause might be easily overlooked. Here we report on the rare cause of a patient with recurrent stroke.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29595639
OWN - NLM
STAT- MEDLINE
DCOM- 20180405
LR  - 20180405
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 13
DP  - 2018 Mar
TI  - An overlooked cause in a patient with recurrent ischemic stroke: A case report.
PG  - e0146
LID - 10.1097/MD.0000000000010146 [doi]
AB  - RATIONALE: The majority of ischemic strokes are due to cardioembolism, large
      vessel atherothromboembolism, small vessel occlusive disease, or other unusual
      mechanisms. In most clinical settings, many strokes without a well-defined
      etiology requires a thorough diagnostic evaluation, otherwise the underlying
      cause might be easily overlooked. Here we report on the rare cause of a patient
      with recurrent stroke. PATIENT CONCERNS: A 50-year-old female patient had a
      4-year history of recurrent acute onset of neurological deficits. DIAGNOSES:
      Contrast transcranial Doppler ultrasound detected a typical "curtain" appearance 
      of microbubbles, indicative of a right-to-left shunt. Computed tomography
      pulmonary angiogram was then initiated and a pulmonary arteriovenous malformation
      (PAVM) in the left lower lobe was found. INTERVENTIONS: The patient underwent
      percutaneous closure of PAVM. Afterward, warfarin was commenced because of the
      high risk of further thromboembolic complications in the following weeks to
      months. Post-treatment computed tomography pulmonary angiogram (CTPA)
      demonstrated successful closure of PAVM. No microbubble signals were detected on 
      post-treatment contrast transcranial Doppler ultrasound (TCD) study. OUTCOMES:
      The patient suffered no further embolic events during 3-year follow-up. No
      recanalization or new PAVMs were detected on CT scan. LESSONS: Neurological
      PAVM-associated risks are common but remain poorly recognized. A strategic
      protocol is imperative in searching for the etiologies of cryptogenic stroke.
FAU - Yang, Xunzhe
AU  - Yang X
AD  - Department of Neurology.
FAU - Liu, Mingsheng
AU  - Liu M
AD  - Department of Neurology.
FAU - Zhu, Yicheng
AU  - Zhu Y
AD  - Department of Neurology.
FAU - Zhang, Xiaobo
AU  - Zhang X
AD  - Department of Radiology, Peking Union Medical College Hospital, Chinese Academy
      of Medical Sciences.
FAU - Gao, Shan
AU  - Gao S
AD  - Department of Neurology.
FAU - Ni, Jun
AU  - Ni J
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - Pulmonary Arteriovenous Fistulas
SB  - AIM
SB  - IM
MH  - Arteriovenous Fistula/*complications/*diagnostic imaging/surgery
MH  - Brain Ischemia/diagnostic imaging/*etiology/therapy
MH  - Computed Tomography Angiography
MH  - Female
MH  - Humans
MH  - Middle Aged
MH  - Pulmonary Artery/*abnormalities/diagnostic imaging/surgery
MH  - Pulmonary Veins/*abnormalities/diagnostic imaging/surgery
MH  - Recurrence
MH  - Stroke/diagnostic imaging/*etiology/therapy
EDAT- 2018/03/30 06:00
MHDA- 2018/04/06 06:00
CRDT- 2018/03/30 06:00
PHST- 2018/03/30 06:00 [entrez]
PHST- 2018/03/30 06:00 [pubmed]
PHST- 2018/04/06 06:00 [medline]
AID - 10.1097/MD.0000000000010146 [doi]
AID - 00005792-201803300-00012 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Mar;97(13):e0146. doi: 10.1097/MD.0000000000010146.