Stroke and Respiratory Failure: Mind the Shunt!
  • Diana Mano
    Centro Hospitalar e Universitário do Porto, Porto, Portugal
  • Patrícia Campos
    Centro Hospitalar e Universitário do Porto, Porto, Portugal
  • Bruno Vale
    Centro Hospitalar e Universitário do Porto, Porto, Portugal
  • Alexandre Pinto
    Centro Hospitalar e Universitário do Porto, Porto, Portugal

Keywords

Ischaemic stroke, pulmonary shunt, paradoxical embolism, platypnoea-orthodeoxia syndrome

Abstract

When stroke patients present with respiratory failure, the first thought that clinicians have is that it is probably related to aspiration pneumonia. However, other causes should be considered, such as intracardiac or intrapulmonary shunts, that could present with paradoxical embolism. Paradoxical embolism is a rare entity defined by the occurrence of a venous thrombotic event associated with a systemic arterial embolism. Frequently, paradoxical embolism presents with platypnoea-orthodeoxia syndrome. Platypnoea-orthodeoxia syndrome is uncommon and is characterized by dyspnoea and hypoxaemia induced by orthostatic position, where symptoms and oxygenation are relieved by recumbency. The authors report a case of a patient who presented with an ischaemic stroke and progression to platypnoea-orthodeoxia syndrome with documentation of simultaneous pulmonary embolism and pulmonary arteriovenous malformations.

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References

  • Windecker S, Stortecky S, Meier B. Paradoxical embolism. J Am Coll Cardiol 2014;64(4):403–415.
  • Burchell HB, Helmholz HF, Wood EH. Reflex orthostatic dyspnea associated with pulmonary hypertension. Am J Physiol 1949;159:563–564.
  • Cheng TO. Mechanisms of platypnea-orthodeoxia: what causes water to flow uphill? Circulation 2002;105:e47.
  • Cheng TO. Platypnea-orthodeoxia syndrome: etiology, differential diagnosis, and management. Cathet Cardiovasc Interv 1999;47:64–66.
  • Swanson KL, Prakash UBS, Stanson AW. Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982–1997. Mayo Clin Proc 1999;74:671–680.
  • Majumdar S, McWilliams JP. Approach to pulmonary arteriovenous malformations: a comprehensive update. J Clin Med 2020;9:1927.
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    Published: 2021-12-16
    Issue: 2021: Vol 8 No 12 (view)


    How to cite:
    1.
    Mano D, Campos P, Vale B, Pinto A. Stroke and Respiratory Failure: Mind the Shunt!. EJCRIM 2021;8 doi:10.12890/2021_003094.