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Journal of Postgraduate Medicine
Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India
ISSN: 0022-3859 EISSN: 0022-3859
Vol. 56, No. 3, 2010, pp. 206-208
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Bioline Code: jp10056
Full paper language: English
Document type: Case Report
Document available free of charge
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Journal of Postgraduate Medicine, Vol. 56, No. 3, 2010, pp. 206-208
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Paradoxical embolism causing stroke and migraine
Nightingale, S. & Ray, G. S.
Abstract
This case report describes a lady who underwent investigations as a part of a clinical study. A 32-year-old woman with a history of episodes of severe migraine with aura, deep vein thrombosis and recurrent epistaxis, presented with two episodes of stroke with no particular cause evident on routine investigations. A contrast echocardiogram demonstrated a patent foramen ovale (PFO). She was found to be positive for the Factor V Leiden mutation. The PFO was closed percutaneously. However, a substantial right to left shunt of 14% persisted. Pulmonary angiography revealed multiple arterio-venous malformations (AVMs) and she was diagnosed with hereditary hemorrhagic telangiectasia. The AVMs were embolized and she has had no further cerebral events. Interestingly, her episodes of ′migraine′ have also improved dramatically following the closure of the PFO and the embolization of the AVMs. This case demonstrates the complex relationship between right to left shunts, cryptogenic stroke and migraine.
Keywords
Cryptogenic stroke, hereditary hemorrhagic telangiectasia, migraine, patent foramen ovale
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