Case of paradoxical cerebral embolism after COVID-19 treated using rt-PA and PFO closure

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  • Uemura Junichi
    Department of Stroke Medicine, Kawasaki Medical School, General Medical Center Department of Stroke Medicine, Kawasaki Medical School
  • Yamashita Shinji
    Department of Stroke Medicine, Kawasaki Medical School, General Medical Center Department of Stroke Medicine, Kawasaki Medical School
  • Yagita Yoshiki
    Department of Stroke Medicine, Kawasaki Medical School
  • Inoue Takeshi
    Department of Stroke Medicine, Kawasaki Medical School, General Medical Center Department of Stroke Medicine, Kawasaki Medical School

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  • COVID-19に合併した奇異性脳塞栓症にアルテプラーゼ静注療法と卵円孔閉鎖術を行った1例

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Abstract

<p>A 54-year-old woman observed sudden difficulty in finding the correct words accompanied by weakness in her right hand 9 days after COVID-19. Head magnetic resonance imaging revealed acute cerebral infarction in the left middle cerebral artery (MCA) territory, and magnetic resonance angiography (MRA) revealed left MCA occlusion. She received recombinant tissue plasminogen activator (rt-PA) therapy and improved immediately thereafter. Head MRA performed 1 h later revealed recanalization of the left MCA. Transcranial ultrasonography (TCD) showed a right-to-left shunt, and lower extremity venous echocardiography revealed an isoluminous organized thrombus in the left soleus vein. Transesophageal echocardiography revealed Grade III patent foramen ovale and an atrial septal aneurysm. We diagnosed paradoxical cerebral embolism in the patient, and initiated apixaban therapy and performed foramen ovale closure. There are few reports of paradoxical embolism in COVID-19, and hence, we discuss the mechanism and treatment of paradoxical cerebral embolism involved in COVID-19.</p>

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