A case report of platypnea-orthodeoxia syndrome: A rare condition found during diagnostic workup of a patient with embolic stroke of undetermined sources
Platypnea-orthodeoxia syndrome (POS) is a rare condition wherein the magnitude of the interatrial shunt changes between the sitting and supine positions. We diagnosed POS in a case initially considered to be of embolic stroke of undetermined source and performed emergency foramen ovale closure as de...
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| Published in | eNeurologicalSci Vol. 26; p. 100393 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
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Elsevier B.V
01.03.2022
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| Abstract | Platypnea-orthodeoxia syndrome (POS) is a rare condition wherein the magnitude of the interatrial shunt changes between the sitting and supine positions. We diagnosed POS in a case initially considered to be of embolic stroke of undetermined source and performed emergency foramen ovale closure as definitive management for the patient. In this case, additional risk factors for POS include spinal deformity, meandering of the aorta, and exclusion of the right atrium due to overextension. Transcranial color flow imaging is recommended for the diagnosis of POS because of its sensitivity, specificity, and non-invasiveness. Although POS is an important barrier to effective rehabilitation, early diagnosis and definitive management lead to dramatic clinical improvement.
•In POS, the magnitude of the interatrial shunt changes during repositioning.•TC-CFI is recommended for diagnosing POS due to its sensitivity and specificity.•Early diagnosis and definitive management lead to dramatic clinical improvement. |
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| AbstractList | Platypnea-orthodeoxia syndrome (POS) is a rare condition wherein the magnitude of the interatrial shunt changes between the sitting and supine positions. We diagnosed POS in a case initially considered to be of embolic stroke of undetermined source and performed emergency foramen ovale closure as definitive management for the patient. In this case, additional risk factors for POS include spinal deformity, meandering of the aorta, and exclusion of the right atrium due to overextension. Transcranial color flow imaging is recommended for the diagnosis of POS because of its sensitivity, specificity, and non-invasiveness. Although POS is an important barrier to effective rehabilitation, early diagnosis and definitive management lead to dramatic clinical improvement.
•
In POS, the magnitude of the interatrial shunt changes during repositioning.
•
TC-CFI is recommended for diagnosing POS due to its sensitivity and specificity.
•
Early diagnosis and definitive management lead to dramatic clinical improvement. Platypnea-orthodeoxia syndrome (POS) is a rare condition wherein the magnitude of the interatrial shunt changes between the sitting and supine positions. We diagnosed POS in a case initially considered to be of embolic stroke of undetermined source and performed emergency foramen ovale closure as definitive management for the patient. In this case, additional risk factors for POS include spinal deformity, meandering of the aorta, and exclusion of the right atrium due to overextension. Transcranial color flow imaging is recommended for the diagnosis of POS because of its sensitivity, specificity, and non-invasiveness. Although POS is an important barrier to effective rehabilitation, early diagnosis and definitive management lead to dramatic clinical improvement.Platypnea-orthodeoxia syndrome (POS) is a rare condition wherein the magnitude of the interatrial shunt changes between the sitting and supine positions. We diagnosed POS in a case initially considered to be of embolic stroke of undetermined source and performed emergency foramen ovale closure as definitive management for the patient. In this case, additional risk factors for POS include spinal deformity, meandering of the aorta, and exclusion of the right atrium due to overextension. Transcranial color flow imaging is recommended for the diagnosis of POS because of its sensitivity, specificity, and non-invasiveness. Although POS is an important barrier to effective rehabilitation, early diagnosis and definitive management lead to dramatic clinical improvement. Platypnea-orthodeoxia syndrome (POS) is a rare condition wherein the magnitude of the interatrial shunt changes between the sitting and supine positions. We diagnosed POS in a case initially considered to be of embolic stroke of undetermined source and performed emergency foramen ovale closure as definitive management for the patient. In this case, additional risk factors for POS include spinal deformity, meandering of the aorta, and exclusion of the right atrium due to overextension. Transcranial color flow imaging is recommended for the diagnosis of POS because of its sensitivity, specificity, and non-invasiveness. Although POS is an important barrier to effective rehabilitation, early diagnosis and definitive management lead to dramatic clinical improvement. Platypnea-orthodeoxia syndrome (POS) is a rare condition wherein the magnitude of the interatrial shunt changes between the sitting and supine positions. We diagnosed POS in a case initially considered to be of embolic stroke of undetermined source and performed emergency foramen ovale closure as definitive management for the patient. In this case, additional risk factors for POS include spinal deformity, meandering of the aorta, and exclusion of the right atrium due to overextension. Transcranial color flow imaging is recommended for the diagnosis of POS because of its sensitivity, specificity, and non-invasiveness. Although POS is an important barrier to effective rehabilitation, early diagnosis and definitive management lead to dramatic clinical improvement. •In POS, the magnitude of the interatrial shunt changes during repositioning.•TC-CFI is recommended for diagnosing POS due to its sensitivity and specificity.•Early diagnosis and definitive management lead to dramatic clinical improvement. |
| ArticleNumber | 100393 |
| Author | Ono, Kenjiro Sugimoto, Azusa Mizuma, Keita Shinke, Toshiro Mochizuki, Yasuhide |
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| Keywords | TC-CFI POS TEE PFO Interatrial shunt ESUS Platypnea-orthodeoxia syndrome (POS) Embolic stroke of undetermined sources (ESUS) Emergency foramen ovale closure Transcranial color flow imaging (TC-CFI) POS, platypnea-orthodeoxia syndrome ESUS, embolic stroke of undetermined sources TC-CFI, transcranial color flow imaging TEE, transesophageal echocardiography PFO, patent foramen ovale |
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| References | Burchell (bb0005) 1949; 159 Cheng (bb0015) 1999; 47 Agrawal, Palkar, Talwar (bb0010) 2017; 129 De Vecchis, Baldi, Ariano, Giasi, Cioppa (bb0020) 2017; 42 Egido, Garcia (bb0025) 2014; 2014 Agrawal (10.1016/j.ensci.2022.100393_bb0010) 2017; 129 Burchell (10.1016/j.ensci.2022.100393_bb0005) 1949; 159 Egido (10.1016/j.ensci.2022.100393_bb0025) 2014; 2014 De Vecchis (10.1016/j.ensci.2022.100393_bb0020) 2017; 42 Cheng (10.1016/j.ensci.2022.100393_bb0015) 1999; 47 40099156 - eNeurologicalSci. 2025 Jan 22;38:100556. doi: 10.1016/j.ensci.2025.100556. |
| References_xml | – volume: 129 start-page: 31 year: 2017 end-page: 38 ident: bb0010 article-title: The multiple dimensions of Platypnea-Orthodeoxia syndrome: a review publication-title: Respir Med – volume: 42 start-page: 384 year: 2017 end-page: 389 ident: bb0020 article-title: Platypnea-orthodeoxia syndrome : orthostatic dyspnea and possible pathophysiological substrates publication-title: Herz – volume: 2014 year: 2014 ident: bb0025 article-title: Transcranial Doppler in the blue stander: the platypnoea-orthodeoxia syndrome revisited publication-title: BMJ Case Rep – volume: 47 start-page: 64 year: 1999 end-page: 66 ident: bb0015 article-title: Platypnea-orthodeoxia syndrome: etiology, differential diagnosis, and management publication-title: Catheter Cardiovasc Interv – volume: 159 start-page: 563 year: 1949 end-page: 564 ident: bb0005 article-title: Reflex orthostatic dyspnea associated with pulmonary hypotension publication-title: Am J Physiol – volume: 159 start-page: 563 year: 1949 ident: 10.1016/j.ensci.2022.100393_bb0005 article-title: Reflex orthostatic dyspnea associated with pulmonary hypotension publication-title: Am J Physiol – volume: 2014 year: 2014 ident: 10.1016/j.ensci.2022.100393_bb0025 article-title: Transcranial Doppler in the blue stander: the platypnoea-orthodeoxia syndrome revisited publication-title: BMJ Case Rep doi: 10.1136/bcr-2014-207440 – volume: 129 start-page: 31 year: 2017 ident: 10.1016/j.ensci.2022.100393_bb0010 article-title: The multiple dimensions of Platypnea-Orthodeoxia syndrome: a review publication-title: Respir Med doi: 10.1016/j.rmed.2017.05.016 – volume: 47 start-page: 64 year: 1999 ident: 10.1016/j.ensci.2022.100393_bb0015 article-title: Platypnea-orthodeoxia syndrome: etiology, differential diagnosis, and management publication-title: Catheter Cardiovasc Interv doi: 10.1002/(SICI)1522-726X(199905)47:1<64::AID-CCD15>3.0.CO;2-6 – volume: 42 start-page: 384 year: 2017 ident: 10.1016/j.ensci.2022.100393_bb0020 article-title: Platypnea-orthodeoxia syndrome : orthostatic dyspnea and possible pathophysiological substrates publication-title: Herz doi: 10.1007/s00059-016-4479-4 – reference: 40099156 - eNeurologicalSci. 2025 Jan 22;38:100556. doi: 10.1016/j.ensci.2025.100556. |
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| SubjectTerms | Case Report Embolic stroke of undetermined sources (ESUS) Emergency foramen ovale closure Interatrial shunt Platypnea-orthodeoxia syndrome (POS) Transcranial color flow imaging (TC-CFI) |
| Title | A case report of platypnea-orthodeoxia syndrome: A rare condition found during diagnostic workup of a patient with embolic stroke of undetermined sources |
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