A Case of Paradoxical Cerebral Embolism Due to Pulmonary Arteriovenous Fistula Mimicking Vertebral Artery Dissection With Wallenberg Syndrome

Abstract

Pulmonary arteriovenous fistula (PAVF) leads to paradoxical cerebral embolism, which can be fatal if left untreated. We report a rare case of brainstem infarction with acute severe headache and Wallenberg syndrome caused by a PAVF mimicking vertebral artery (VA) dissection. A 40-year-old man presented with a sudden occipital headache accompanied by right hemisensory disturbance. Magnetic resonance imaging revealed left lateral medullary infarction and poor depiction of the left VA. However, it was clearly recanalized on day six, and there were no findings of VA dissection. Whole-body contrast-enhanced computed tomography (CT) revealed a PAVF in the right lung and a thrombus in the feeding artery. The patient was diagnosed with hereditary hemorrhagic telangiectasia due to recurrent epistaxis and peripheral vasodilation of the tongue. An anticoagulant was administered for preventing further ischemic stroke, and a follow-up CT confirmed the disappearance of the thrombus in three months. Thoracoscopic partial lung resection was performed five months after the onset, and no recurrence of ischemic stroke was observed.

Isolated Pulmonary Arteriovenous Fistula Related Stroke with Large Vessel Occlusions Successfully Recanalized by Recombinant Tissue Plasminogen Activator： a case report

“…Only one of the case reports described a proximal (M1-middle cerebral artery) large vessel occlusion(8), and another reported a right M2-MCA occlusion (9). Besides, a case report described a PAVF mimicking vertebral artery dissection (10). In this case, both CCA and M2-MCA had thrombi, and was thought to be arterial-to-arterial embolism at rst.…”