Ischaemic stroke associated with pulmonary arteriovenous malformation
A. V. Belopasova,
A. A. Kulesh,
S. A. Mekhrykov,
L. I. Syromyatnikova,
A. O. Chechetkin,
A. R. Karshieva,
L. A. Dobrynina https://doi.org/10.30629/2658-7947-2022-27-4-27-36
Abstract
Pulmonary arteriovenous malformation (PAVM) is considered a rare cause of ischaemic stroke in young patients. In this article, we present a case series of 5 patients with PAVM-associated ischaemic stroke. We discuss pathophysiology, clinical presentation, diagnostic approaches, and secondary prevention. In addition, two of the aforementioned cases are provided in detail: the one of 32-year-old female with ischaemic stroke associated with sporadic PAVM, the latter being treated with embolization, and the one of 24-year-old male with hereditary hemorrhagic telangiectasia (HHT) who developed PAVM-associated ischaemic stroke, who was treated with intravenous thrombolytic therapy and mechanical thrombectomy on admission, followed by video-assisted thoracoscopic PAVM resection.
About the Authors
A. V. Belopasova
Research Center of Neurology
Russian Federation
Russian Federation
Moscow
A. A. Kulesh
Perm State Medical University named after Academician E.A. Wagner; 4th City Clinical Hospital of Perm
Russian Federation
Russian Federation
Perm
S. A. Mekhrykov
4th City Clinical Hospital of Perm
Russian Federation
Russian Federation
Perm
L. I. Syromyatnikova
Perm State Medical University named after Academician E.A. Wagner; 4th City Clinical Hospital of Perm
Russian Federation
Russian Federation
Perm
A. O. Chechetkin
Research Center of Neurology
Russian Federation
Russian Federation
Moscow
A. R. Karshieva
Research Center of Neurology
Russian Federation
Russian Federation
Moscow
L. A. Dobrynina
Research Center of Neurology
Russian Federation
Russian Federation
Moscow
References
1. Ekker M.S., Boot E.M., Singhal A.B., Tan K.S., Debette S., Tuladhar A.M., de Leeuw F.E. Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol. 2018;17(9):790–801. doi: 10.1016/S1474-4422(18)30233-3
2. Kalashnikova L.A., Dobrynina L.A. Ischemic stroke in young adults. Zh Nevrol Psikhiatr im S.S. Korsakova. 2017;117(8;2):3–12. (In Russian). doi:10.17116/jnevro2017117823-12
3. Kulesh A.A., Nurieva Yu.A., Syromyatnikova L.I. Causes of ischemic stroke in patients younger than 45 years: analysis of data from the regional vascular center. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(1):24–30. (In Russian). https://doi.org/10.14412/2074-2711-2021-1-24-30
4. Mekhryakov S.A., Kulesh A.A., Pokalenko E.A., Syromyatnikova L.I., Kulikova S.P., Drobakha V.E. et al. The paradoxical embolism phenomenon in patients with embolic cryptogenic stroke. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(1):13–21. (In Russian). https://doi.org/10.14412/2074-2711-2020-1-13-21
5. Faughnan M.E., Mager J.J., Hetts S.W., Palda V.A., Lang-Robertson K., Buscarini E. et al. Second International Guidelines for the Diagnosis and Management of Hereditary Hemorrhagic Telangiectasia. Ann Intern Med. 2020;173(12):989–1001. doi: 10.7326/M20-1443
6. Cartin-Ceba R., Swanson K.L., Krowka M.J. Pulmonary arteriovenous malformations. Chest. 2013;144(3):1033–1044. doi: 10.1378/chest.12-0924
7. Saboo S.S., Chamarthy M., Bhalla S., Park H., Sutphin P., Kay F. et al. Pulmonary arteriovenous malformations: diagnosis. Cardiovasc Diagn Ther. 2018;8(3):325–337. doi: 10.21037/cdt.2018.06.01
8. Shovlin C.L. Pulmonary arteriovenous malformations. Am J Respir Crit Care Med. 2014;190:1217–28. doi: 10.1164/rccm.201407-1254CI
9. Horner S., Niederkorn K., Gattringer T., Furtner M., Topakian R., Lang W. et al. Management of right-to-left shunt in cryptogenic cerebrovascular disease: results from the observational Austrian paradoxical cerebral embolism trial (TACET) registry. J Neurol. 2013;260(1):260–7. doi: 10.1007/s00415-012-6629-9
10. Topiwala K.K., Patel S.D., Pervez M., Shovlin C.L., Alberts M.J. Ischemic Stroke in Patients with Pulmonary Arteriovenous Fistulas. Stroke. 2021;52(7):e311–e315. doi: 10.1161/STROKEAHA.120.032073
11. Wozniak L., Mielczarek M., Sabiniewicz R. Paradoxical brain embolism in a young man: is it only a patent foramen ovale? Neurol Neurochir Pol. 2015;49(1):61–4. doi: 10.1016/j.pjnns.2014.12.003
12. Anticoli S., Pezzella F.R., Siniscalchi A., Gallelli L., Bravi M.C. Pulmonary arteriovenous malformation as a cause of embolic stroke: case report and review of the literature. Interv Neurol. 2015;3(1):27–30. doi: 10.1159/000368969
13. Saidman J., Abdou H., Sampath Kumar S. Stroke resulting from an isolated pulmonary arteriovenous malformation. BMJ Case Rep. 2017;2017:bcr2017221000. doi: 10.1136/bcr-2017-221000
14. Belopasova A.V., Dobrynina L.A., Kalashnikova L.A., Chechetkin A.O., Karshieva A.R., Abugov S.A. et al. Pulmonary arteriovenous shunt — a rare cause of recurrent stroke due to paradoxical embolism. Zh Nevrol Psikhiatr Im S.S. Korsakova. 2020;120(9):107–113. (In Russian). doi: 10.17116/jnevro2020120091107
15. Cappa R., Du J., Carrera J.F., Berthaud J.V., Southerland A.M. Ischemic Stroke Secondary to Paradoxical Embolism Through a Pulmonary Arteriovenous Malformation: Case Report and Review of the Literature. J Stroke Cerebrovasc Dis. 2018;27(7):e125–e127. doi: 10.1016/j.jstrokecerebrovasdis.2018.02.015
16. Zanati Bazan S.G, Braga G.P., Luvizutto G.J., Trindade A.P., Pontes-Neto O.M., Bazan R. Bihemispheric Paradoxical Cerebral Embolism in a Patient with Pulmonary Thromboembolism and Presumptive Fistula Right-to-Left Shunt. J Stroke Cerebrovasc Dis. 2016;25(6):e95 — 7. doi: 10.1016/j.jstrokecerebrovasdis.2016.03.038
17. Velthuis S., Buscarini E., van Gent M.W.F., Gazzaniga P., Manfredi G., Danesino C. et al. Grade of pulmonary right-to-left shunt on contrast echocardiography and cerebral complications: a striking association. Chest. 2013;144(2):542–548. doi: 10.1378/chest.12-1599
18. Pareés I., Horga A., Santamarina E., Mendióroz M., FernándezCádenas I., del Río-Espínola A., Alvarez-Sabín J. Stroke after prolonged air travel associated with a pulmonary arteriovenous malformation. J Neurol Sci. 2010;292(1-2):99–100. doi: 10.1016/j.jns.2010.02.019
19. Yassi N., Yan B., Dowling R., Mitchell P.J. A rare cause of embolic stroke in hereditary hemorrhagic telangiectasia. J Stroke Cerebrovasc Dis. 2014;23(5):1245–6. doi: 10.1016/j.jstrokecerebrovasdis.2013.07.037
20. Bosher L.H. Jr., Blake D.A., Byrd B.R. An analysis of the pathologic anatomy of pulmonary arteriovenous aneurysms with particular reference to the applicability of local excision. Surgery. 1959;45(1):91–104.
21. Cannella R., Sparacia G., Lo Re V., Oddo E., Mamone G., Miraglia R. Advanced magnetic resonance imaging of cortical laminar necrosis in patients with stroke. Neuroradiol J. 2019;32(6):431–437. doi: 10.1177/1971400919876621
22. Lin G., Jiang P., Lou M. Thrombolysis in Ischemic Stroke Patients with Isolate Pulmonary Arteriovenous Malformations. J Stroke Cerebrovasc Dis. 2019;28(6):e68–e70. doi: 10.1016/j.jstrokecerebrovasdis.2019.03.004
23. Hasegawa I., Abe T., Mino T., Okamoto K., Takeda A., Itoh Y. Paradoxical Brain Embolism Caused by Isolated Pulmonary Arteriovenous Fistula Successfully Treated with Recombinant Tissue Plasminogen Activator. J Stroke Cerebrovasc Dis. 2019;28(7):e100–e101. doi: 10.1016/j.jstrokecerebrovasdis.2019.03.048
24. Saric M., Armour A.C., Arnaout M.S., Chaudhry F.A., Grimm R.A., Kronzon I. et al. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism. J Am Soc Echocardiogr. 2016;29(1):1–42. doi: 10.1016/j.echo.2015.09.011
25. Porter T.R., Abdelmoneim S., Belcik J.T., McCulloch M.L., Mulvagh S.L., Olson J.J. et al. Guidelines for the cardiac sonographer in the performance of contrast echocardiography: a focused update from the American Society of Echocardiography. J Am Soc Echocardiogr. 2014;27(8):797–810. doi: 10.1016/j.echo.2014.05.011
26. Shovlin C.L., Guttmacher A.E., Buscarini E., Faughnan M.E., Hyland R.H., Westermann C.J. et al. Diagnostic criteria for hereditary hemorrhagic telangiectasia (Rendu–Osler–Weber syndrome). Am J Med Genet. 2000;91(1):66–7. doi: 10.1002/(sici)1096-8628(20000306)91:1<66::aid-ajmg12>3.0.co;2-p
27. Shin J.H., Park S.J., Ko G.Y., Yoon H.K., Gwon D.I., Kim J.H., Sung K.B. Embolotherapy for pulmonary arteriovenous malformations in patients without hereditary hemorrhagic telangiectasia. Korean J Radiol. 2010;11(3):312–9. doi: 10.3348/kjr.2010.11.3.312
28. Shovlin C.L., Jackson J..E., Bamford K.B., Jenkins I.H., Benjamin A.R., Ramadan H., Kulinskaya E. Primary determinants of ischaemic stroke/brain abscess risks are independent of severity of pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia. Thorax. 2008;63(3):259–66. doi: 10.1136/thx.2007.087452
29. Holden V.K., Shah N.G., Verceles A.C. Implications of an Incidental Pulmonary Arteriovenous Malformation. J Investig Med High Impact Case Rep. 2016;4(1):2324709616637190. doi: 10.1177/2324709616637190
30. Chechetkin A.O., Karshieva A.R., Kravchenko M.A., Belopasova A.V., Kalashnikova L.A., Dobrynina L.A. Legochnyi arterio-venoznyi shunt kak prichina paradoksal’noi embolii: vozmozhnosti ul’trazvukovoi diagnostiki. Vestnik voenno-meditsinskoi akademii. 2019;3(67):162–164. (In Russ.). doi: 10.32863/1682-7392-2019-3-67-162-164
31. Morphet J.A. Osler–Weber–Rendu syndrome. CMAJ. 2006;175(10):1243. doi: 10.1503/cmaj.1060182
32. Borgdorff P., Tangelder G.J. Migraine: possible role of shearinduced platelet aggregation with serotonin release. Headache. 2012;52(8):1298–318. doi: 10.1111/j.15264610.2012.02162.x
33. Takano T., Tian G.F., Peng W., Lou N., Lovatt D., Hansen A.J. et al. Cortical spreading depression causes and coincides with tissue hypoxia. Nat Neurosci. 2007;10(6):754–62. doi: 10.1038/nn1902
34. Noble S., Perren F., Roffi M. Cryptogenic stroke with right-to-left shunt and no patent foramen ovale. Arch Cardiovasc Dis. 2014;107(6–7):418–9. doi: 10.1016/j.acvd.2012.07.004
35. Barbaryan A., Bailuc S., Raqeem M.W., Kak M., Derani L., Mirrakhimov A.E. Wake-Up Call: Pulmonary Arteriovenous Malformation. Am J Med. 2017;130(3):290–292. doi: 10.1016/j.amjmed.2016.10.021
36. Patti G., D’Antonio L., Sedati P., Mega S., Di Sciascio G. Percutaneous closure of a pulmonary arteriovenous malformation in young patient with cryptogenic stroke. JACC Cardiovasc Interv. 2013;6(5):e26–7. doi: 10.1016/j.jcin.2012.11.016
37. Ishikawa Y., Yamanaka K., Nishii T., Fujii K., Rino Y., Maehara T. Video-assisted thoracoscopic surgery for pulmonary arteriovenous malformations: report of five cases. Gen Thorac Cardiovasc Surg. 2008;56(4):187–90. doi: 10.1007/s11748-007-0215-6
38. Nakamura H., Miwa K., Haruki T., Adachi Y., Fujioka S., Taniguchi Y. Pulmonary arteriovenous fistula with cerebral infarction successfully treated by video-assisted thoracic surgery. Ann Thorac Cardiovasc Surg. 2008;14(1):35–7.
39. da Cruz M., Palma N.Z., Rocha J., Meireles R. Pulmonary Arteriovenous Malformation can be Associated with Embolic Stroke of Undetermined Source (ESUS). Eur J Case Rep Intern Med. 2019;6(11):001262. doi: 10.12890/2019_001262
Review
For citations:
Belopasova A.V., Kulesh A.A., Mekhrykov S.A., Syromyatnikova L.I., Chechetkin A.O., Karshieva A.R., Dobrynina L.A. Ischaemic stroke associated with pulmonary arteriovenous malformation. Russian neurological journal. 2022;27(4):27-36. (In Russ.) https://doi.org/10.30629/2658-7947-2022-27-4-27-36
Views:
703
Email this article 