Diagnosis and Management of Ischemic Stroke Secondary to Pulmonary Embolism in Elderly Patients

Abstract

Timely diagnosis and management of pulmonary embolism-induced ischemic stroke in elderly patients pose significant challenges. Definitive diagnosis relies on comprehensive imaging studies like non-contrast brain MRI and computed tomography pulmonary angiography to identify and locate affected vascular territories. Transthoracic echocardiogram with agitated saline contrast proves valuable in understanding potential causes of acute ischemic stroke, aiding in detecting Patent Foramen Ovale (PFO)or intra-atrial thrombi, and providing insights into PE severity through right heart strain identification. TTE's prognostic value helps predict the condition's outcome, while Transesophageal echocardiogram accompanies TTE when results are inconclusive. Lower extremity ultrasound is crucial for comprehensive deep vein thrombosis evaluation in elderly patients, and considering occult malignancy workup (pan scan) and pelvic MR Venogram for May-Thurner syndrome is important. However, limited information on testing frequency for occult malignancy and MTS may contribute to the presence of both PFO and DVTs in multiple patients. Treatment approaches for PE-induced ischemic stroke vary based on severity and individual considerations. Acute thrombolysis with intravenous recombinant tissue plasminogen activator and mechanical thrombectomy effectively manageAIS. Intravenous heparin is a common choice for systemic anticoagulation in PE, necessitating prompt initiation to avoid worsening outcomes. However, anticoagulation alone for AIS does not improve prognosis or prevent future occurrences. Prompt IV rt-PA consideration in severe AIS cases with a high risk of hemorrhagic conversion is crucial. While having a stroke in the past six months is an absolute contraindication for PE thrombolytic therapy, it may be considered relative in life-threatening PE scenarios. In conclusion, S. OKtimelydiagnosis and appropriate management of PE-induced ischemic stroke in elderly patients necessitate a multidisciplinary approach. Integrating imaging studies, echocardiograms, and comprehensive thrombosis and malignancy evaluations is vital.