A Multidisciplinary Approach to a Complicated Acute Paradoxical Embolism via a Patent Foramen Ovale

Ian Diebels, Tim Wessels, Johan Goovaerts, Michael Schreurs, Catherine Gorris, Philippe De Vleeschauwer, Marc Dubois

Abstract


We report a case of a 43-year-old male with a history of migraine with aura and a heterozygous factor V Leiden deficiency presenting with a complicated paradoxical arterial embolism of a deep vein thrombosis via a patent foramen ovale (PFO). Recovery was complicated with a dropfoot due to a reperfusion compartment syndrome. Treatment involved a multidisciplinary approach including embolectomy, fasciotomy, percutaneous PFO closure and extensive rehabilitation. At 5-month follow-up, the patient reported significant improvement in pain, sensation, strength and function of his leg. Repeat electromyography showed reinnervation potentials and improvement of maximal contraction in muscles innervated by the tibial and peroneal nerve, where the latter was not fully restored; however, the patient was able to walk independently again without orthosis and had restarted working. In conclusion, a complicated paradoxical embolism should be treated in a multidisciplinary setting to optimize diagnostic approach, treatment and rehabilitation.




J Med Cases. 2017;8(9):287-292
doi: https://doi.org/10.14740/jmc2897w


Keywords


Paradoxical embolism; Thrombectomy; Patent foramen ovale; Factor V Leiden; Compartment syndrome; Peroneal neuropathy

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