Clinical features of ischemic stroke and transient ischemic attack associated with suspicious pulmonary arteriovenous fistula detected only by transesophageal echocardiography

• Published in: Neurosonology Vol. 28; no. 3; pp. 134 - 138
• Main Authors: KURIKI, Ayako, KATOU, Hirotaka, MIZUMA, Keita, SAITO, Yu, KAMIYA, Yuki, KAWAMURA, Mitsuru
• Format: Journal Article
• Language: Japanese
• Published: The Japan Academy of Neurosonology 2015
• Subjects: ischemic stroke; pulmonary arteriovenous fistula; transesophageal echocardiography
• ISSN: 0917-074X; 1884-3336
• DOI: 10.2301/neurosonology.28.134

Background: Suspected pulmonary arteriovenous fistula (PAVF) on transesophageal echocardiography (TEE) is sometimes difficult to prove with examinations such as contrast-enhanced (CE) CT. Methods: Clinical features were investigated in 19 patients with ischemic stroke (14 men; mean age, 60.8 y) with suspected PAVF on TEE but unproven on further examinations. Patients with atrial fibrillation, aortic atherosclerosis, ipsilateral carotid or intracranial stenosis and other risks of stroke such as vasculopathies, hypercoagulable states, or hematologic disorders were excluded. Results: The infarct region was in the territory of the unilateral middle cerebral artery in 12 cases, bilateral in 1 case, posterior cerebral artery in 1 case, vertebrobasilar artery in 2 cases, internal carotid artery in 1 case, and undetermined in 2 cases. CECT was performed in 17 cases (including 3D CT reconstruction in 7 cases), ventilation/perfusion lung scintigraphy in 1 case, and CE-MRI in 1 case. Modified Rankin Scale (mRS) scores at discharge were 0, 1, 2 and 3 in 7, 6, 1 and 4 cases, respectively, and 4 in a case complicated by Wernicke's encephalopathy. In 2 cases in which PAVF was proven on CECT, the mRS scores were 2 and 5. Conclusion: Patients with unproven PAVF tended to have better outcomes than those with proven PAVF. Patients with unproven PAVF may have small PAVFs or shunts unrelated to stroke that still require comprehensive treatment due to other risks and pathologies.