Paradoxical Embolism to the Central Nervous System After Sexual Intercourse in a Young Woman with a Complex Atrial Septal Abnormality

• Published in: Journal of stroke and cerebrovascular diseases Vol. 17; no. 5; pp. 320 - 324
• Main Authors: Velicu, Simona, MD, Biller, José, MD, Hacein-Bey, Lotfi, MD, Freihage, Jeffrey H., MD, Leya, Fred, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2008
• Subjects: Adult; Anticoagulants - therapeutic use; atrial septal abnormality; Cardiovascular; Cerebral Angiography; Echocardiography; Female; Fibrinolytic Agents - therapeutic use; Foramen Ovale, Patent - complications; Heart Aneurysm - complications; Heart Septal Defects, Atrial - complications; Heparin - therapeutic use; Humans; Infarction, Middle Cerebral Artery - drug therapy; Infarction, Middle Cerebral Artery - pathology; intra-arterial thrombolysis; Leg - blood supply; Neurology; paradoxical embolism; patent foramen ovale; Physical Exertion; Sexual Behavior - physiology; Stroke; Thrombolytic Therapy - methods; tissue plasminogen activator; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; Venous Thrombosis - complications; Stroke; patent foramen ovale; tissue plasminogen activator; paradoxical embolism; atrial septal abnormality; intra-arterial thrombolysis
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2008.02.001

Ischemic stroke during sexual intercourse is an unusual occurrence. We report the evaluation and treatment of a young woman on oral contraceptives, with a complex atrial septal abnormality and right lower extremity deep vein thrombus, who had an ischemic stroke during sexual intercourse. Successful treatment was accomplished with administration of intra-arterial tissue plasminogen activator and subsequent transvascular occlusion of the atrial septal abnormality.