SHM Converge Scientific Abstract ePoster Gallery-Paradoxical Stroke in Young Male With Severe Hypercoaguable State Status Post Cauda Equina Syndrome

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This poster presents a case of paradoxical embolic stroke in a 37-year-old man with prior DVT on rivaroxaban who developed cauda equina syndrome after heavy squatting and underwent urgent lumbar decompression surgery. On postoperative day 3, he acutely deteriorated with chest pain, syncope, and severe hypoxia. CTA confirmed submassive bilateral pulmonary emboli, requiring intubation, thrombolysis, and mechanical thrombectomy. He then developed major neurologic deficits, and head CT showed embolic strokes in the right MCA territory and right cerebellum. A large postoperative hematoma required evacuation, and additional DVTs occurred despite anticoagulation.<br /><br />Initial echocardiography and TEE did not reveal a shunt, but a repeat TEE identified a small patent foramen ovale (PFO), explaining the paradoxical embolism. Anticoagulation was adjusted because of bleeding risk, and sequential compression devices were used to reduce further venous thromboembolism.<br /><br />The discussion emphasizes that PFO is common and usually asymptomatic, but it significantly increases the risk of ischemic and perioperative stroke, especially in noncardiac surgery. Evidence cited in the poster shows higher stroke risk, more large-vessel strokes, and worse neurologic outcomes in patients with PFO. The poster highlights that this risk is under-recognized in surgical patients.<br /><br />The authors conclude that preoperative identification of PFO in high-risk patients may improve risk stratification and guide preventive strategies, such as tailored anticoagulation, closer perioperative monitoring, and in selected cases, consideration of PFO closure.

Asset Subtitle

Sara Malik

Meta Tag

Author List Anmol Grewal, Sara Malik

Category Clinical Vignettes

Concept Paradoxical Embolization

Concept Patent Foramen Ovale

Concept Stroke

Concept Pulmonary Embolism

Concept Deep Vein Thrombosis

Distinguished Non-Finalist

Presenter Organization Abrazo Health

Presenting Author Sara Malik

Track Adult

Keywords

paradoxical embolism

patent foramen ovale

pulmonary embolism

ischemic stroke

deep vein thrombosis

cauda equina syndrome

lumbar decompression

perioperative stroke

thrombolysis

mechanical thrombectomy

Paradoxical Embolization

Patent Foramen Ovale

Stroke

Pulmonary Embolism

Deep Vein Thrombosis