A Case of Pulmonary Arteriovenous Malformation Presented with Paradoxical Brain Embolism

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  • 脳梗塞を初発症状とした肺動静脈奇形の1例
  • 症例 脳梗塞を初発症状とした肺動静脈奇形の1例
  • ショウレイ ノウコウソク オ ショハツ ショウジョウ ト シタ ハイドウ ジョウミャク キケイ ノ 1レイ

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Abstract

<p>Pulmonary arteriovenous malformation (PAVM) is a pulmonary vascular anomaly. It is known that affected people can present with paradoxical brain embolism from right-to-left shunt. A 44-year-old woman with no significant family and medical histories presented to our hospital with the sudden onset of headache, dizziness, and aphasia. Magnetic resonance imaging and angiography of the head revealed acute ischemic stroke and occlusion of the right anterior inferior cerebellar artery. Thrombolytic therapy with recombinant tissue plasminogen activator and anticoagulant therapy with warfarin improved her neurological conditions rapidly. Contrast-enhanced transesophageal echocardiography revealed right-to-left shunt. Contrast-enhanced chest computed tomography revealed a PAVM in the segment 10 of the left lung peripherally. Radical resection of the PAVM was performed using video-assisted thoracoscopy (VATS). She was successfully treated without recurrence of the PAVM and stroke during 6 months after the operation. There are many articles reporting that coil embolization is the first choice of treatment for PAVM, but PAVM recurrence is a serious problem after coil embolization. Resection using VATS is a minimally invasive and more effective treatment for PAVMs, and thus could be a practical method for single and peripheral PAVMs. PAVM is an important differential diagnosis of cerebral infarction in younger patients.</p>

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