E F Wijdicks1, J P Scott. 1. Department of Neurology, Mayo Clinic Rochester, MN 55905, USA.
Abstract
OBJECTIVE: To describe the circumstances surrounding pulmonary embolism associated with stroke, the prophylactic measures, and the outcome in affected patients. MATERIAL AND METHODS: We studied pulmonary embolism in patients with acute stroke at Mayo Clinic Rochester during a 2-decade period. Medical records of 30 patients with pulmonary embolus after stroke were reviewed. Pulmonary embolus was diagnosed on the basis of pulmonary angiograms, high-or intermediate-probability ventilation-perfusion scans, or autopsy findings. RESULTS: Sudden death occurred in 15 of 30 patients (50%) with pulmonary embolism. In the other 15 patients, pleuritic pain or dyspnea was a major initial symptom. Pulmonary embolism occurred from day 3 to day 120 (median time, day 20) after the ictus. Prophylaxis against deep venous thrombosis was noted in only 4 of 30 patients. Pulmonary embolism was associated with deep venous thrombosis diagnosed clinically or at autopsy in 11 patients, invariably in the paralyzed leg. CONCLUSION: Pulmonary embolism after ischemic or hemorrhagic stroke may defy antemortem diagnosis in half of the affected patients. Pulmonary embolism in patients with acute stroke can be a cause of early mortality (during the first month after the ictus).
OBJECTIVE: To describe the circumstances surrounding pulmonary embolism associated with stroke, the prophylactic measures, and the outcome in affected patients. MATERIAL AND METHODS: We studied pulmonary embolism in patients with acute stroke at Mayo Clinic Rochester during a 2-decade period. Medical records of 30 patients with pulmonary embolus after stroke were reviewed. Pulmonary embolus was diagnosed on the basis of pulmonary angiograms, high-or intermediate-probability ventilation-perfusion scans, or autopsy findings. RESULTS:Sudden death occurred in 15 of 30 patients (50%) with pulmonary embolism. In the other 15 patients, pleuritic pain or dyspnea was a major initial symptom. Pulmonary embolism occurred from day 3 to day 120 (median time, day 20) after the ictus. Prophylaxis against deep venous thrombosis was noted in only 4 of 30 patients. Pulmonary embolism was associated with deep venous thrombosis diagnosed clinically or at autopsy in 11 patients, invariably in the paralyzed leg. CONCLUSION:Pulmonary embolism after ischemic or hemorrhagic stroke may defy antemortem diagnosis in half of the affected patients. Pulmonary embolism in patients with acute stroke can be a cause of early mortality (during the first month after the ictus).
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