A Case of Pregnancy with a History of Paradoxical Brain Embolism

Tomoko Adachi; Kazunari Hashiguchi; Yoshio Matsuda; Hiroaki Ohta

doi:10.1055/s-2002-36695

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2002; 28(6): 525-528
DOI: 10.1055/s-2002-36695

A Case of Pregnancy with a History of Paradoxical Brain Embolism

Tomoko Adachi, Kazunari Hashiguchi, Yoshio Matsuda, Hiroaki Ohta

Department of Obstetrics and Gynecology, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan

Abstract

ABSTRACT

Brain embolisms in younger persons are rare but are often caused by a paradoxical embolism, the embolic entry of a venous thrombus into the systemic circulation through a right-to-left shunt. A 27-year-old pregnant woman presented with hemiplegia that had been treated with an antiplatelet agent since the occurrence of a paradoxical brain embolism via the pulmonary arteriovenous fistula. A tendency of hypercoagulation is generally observed during pregnancy, so a patient with this condition has a strong risk factor for venous thromboembolism during pregnancy and even more so for arterial thromboembolism under the intense strain of labor, which is much stronger than that of the Valsalva maneuver. This case had been controlled well with an antiplatelet agent and an anticoagulant while the levels of coagulation and fibrinolytic factors were monitored and was followed by a successful pregnancy outcome.

KEYWORD

Paradoxical embolism - brain embolism - pregnancy - transesophageal echocardiography (TEE) - transcranial Doppler (TCD)

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References

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