BACKGROUND AND PURPOSE: Pulmonary embolism is thought to be associated with a small but definite risk of paradoxical embolism in patients with a patent foramen ovale (PFO). Although neurological complications are infrequent, the incidence of clinically silent brain infarction is unknown. We assessed the rate of clinically apparent and silent cerebral embolism in patients with pulmonary embolism in relation to the presence or not of a PFO. METHODS: We used diffusion-weighted MRI in patients hospitalized for a pulmonary embolism to assess cerebral embolic events. Sixty consecutive patients were evaluated at diffusion-weighted MRI. All patients underwent neurological assessment before diffusion-weighted MRI and a contrast echocardiography to detect PFO the next day. RESULTS: Diffusion-weighted MRI showed bright lesions in 6 patients among the 60 consecutive patients with pulmonary embolism in a pattern consistent with embolic events. There was only one patient with a neurological deficit. After contrast echocardiography, a PFO was diagnosed in 15 patients (25%). The frequency of silent brain infarcts in patients with a PFO was significantly higher than in patients without PFO (5 [33.3%] of 15 versus one [2.2%] of 45 patients, P=0.003). By logistic regression analysis, PFO was identified as an independent predictor of silent brain infarcts (OR, 34.9 [3.1 to 394.3]; P=0.004). CONCLUSIONS: In pulmonary embolism, cerebral embolic events are more frequent than the apparent neurological complication rate. The prevalence of silent brain infarcts is closely related to the presence of a PFO suggesting a high incidence of unsuspected paradoxical emboli in those patients.
BACKGROUND AND PURPOSE:Pulmonary embolism is thought to be associated with a small but definite risk of paradoxical embolism in patients with a patent foramen ovale (PFO). Although neurological complications are infrequent, the incidence of clinically silent brain infarction is unknown. We assessed the rate of clinically apparent and silent cerebral embolism in patients with pulmonary embolism in relation to the presence or not of a PFO. METHODS: We used diffusion-weighted MRI in patients hospitalized for a pulmonary embolism to assess cerebral embolic events. Sixty consecutive patients were evaluated at diffusion-weighted MRI. All patients underwent neurological assessment before diffusion-weighted MRI and a contrast echocardiography to detect PFO the next day. RESULTS: Diffusion-weighted MRI showed bright lesions in 6 patients among the 60 consecutive patients with pulmonary embolism in a pattern consistent with embolic events. There was only one patient with a neurological deficit. After contrast echocardiography, a PFO was diagnosed in 15 patients (25%). The frequency of silent brain infarcts in patients with a PFO was significantly higher than in patients without PFO (5 [33.3%] of 15 versus one [2.2%] of 45 patients, P=0.003). By logistic regression analysis, PFO was identified as an independent predictor of silent brain infarcts (OR, 34.9 [3.1 to 394.3]; P=0.004). CONCLUSIONS: In pulmonary embolism, cerebral embolic events are more frequent than the apparent neurological complication rate. The prevalence of silent brain infarcts is closely related to the presence of a PFO suggesting a high incidence of unsuspected paradoxical emboli in those patients.
Authors: Michael M Dowling; Charles T Quinn; Claudio Ramaciotti; Julie Kanter; Ifeyinwa Osunkwo; Baba Inusa; Rathi Iyer; Janet L Kwiatkowski; Clarissa Johnson; Melissa Rhodes; William Owen; John J Strouse; Julie A Panepinto; Lynne Neumayr; Sharada Sarnaik; Patricia A Plumb; Nomazulu Dlamini; Fenella Kirkham; Linda S Hynan Journal: Br J Haematol Date: 2016-10-21 Impact factor: 6.998
Authors: Mingming Ning; Eng H Lo; Pei-Chen Ning; Su-Yu Xu; David McMullin; Zareh Demirjian; Ignacio Inglessis; G William Dec; Igor Palacios; Ferdinando S Buonanno Journal: Pharmacol Ther Date: 2013-03-23 Impact factor: 12.310
Authors: José Airton de Arruda; Viviana de Mello Guzzo Lemke; José Mariani Júnior; Adriano Henrique Pereira Barbosa; Alexandre Schaan de Quadros; Carlos Augusto Cardoso Pedra; Cristiano de Oliveira Cardoso; Ênio Eduardo Guérios; Henrique Barbosa Ribeiro; Luiz Antonio Gubolino; Maurício Cavalieri Machado; Mauricio Jaramillo Hincapie; Nelson Antonio Moura de Araujo; Raul Ivo Rossi Filho; Ricardo Alves da Costa; Silvio Gioppato Journal: Arq Bras Cardiol Date: 2020-01 Impact factor: 2.000
Authors: Mariëlla E C Hassell; Robin Nijveldt; Yvo B W Roos; Charles B L Majoie; Martial Hamon; Jan J Piek; Ronak Delewi Journal: Nat Rev Cardiol Date: 2013-10-29 Impact factor: 32.419