Thromboembolic stroke associated with thoracic outlet syndrome

Meumann, Ella M.; Chuen, Jason; Fitt, Gregory J; Perchyonok, Yuliya; Pond, Franklin; Dewey, Helen M

doi:10.1016/j.jocn.2013.07.030

Cited by 21 publications

(19 citation statements)

References 24 publications

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“…Stroke due to arterial TOS typically occurs in young adults and is preceded by upper-extremity symptoms in about 81% [ 7 ]. Stroke caused by TOS in children is rare, with 10 children reported in the literature including the current patient ( Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…Arterial TOS is frequently associated with a cervical rib, which occurs in 1% of the population and is rarely symptomatic. Acute ischemic stroke (AIS) has been reported in more than 30 individuals with arterial TOS [ 7 ] and is a rare cause of stroke in children [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. We present a 15-year-old girl with AIS due to TOS, complicated by subclavian artery thrombosis and subsequent embolism, whose stroke was treated with intravenous thrombolysis and mechanical thrombectomy.…”

Section: Introductionmentioning

confidence: 99%

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Pediatric Stroke due to Thoracic Outlet Syndrome Treated with Thrombolysis and Thrombectomy: A Case Report

et al. 2022

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Thoracic outlet syndrome (TOS) is a condition that results from the compression of neurovascular structures as they exit the thorax. Arterial ischemic stroke can occur in TOS due to retrograde embolism from the subclavian artery. We describe a 15-year-old girl who presented with left hemiplegia after 2 weeks of right arm numbness and tingling. Imaging showed an acute ischemic stroke due to a right middle cerebral artery occlusion. She was treated with intravenous tissue plasminogen activator at 1.3 h and mechanical thrombectomy at 2.4 h with successful recanalization. Review of her neck computed tomography angiogram suggested a right subclavian artery aneurysm, and upper-extremity imaging also demonstrated distal thrombosis and fusion of right first and second ribs, which was consistent with thoracic outlet syndrome. Three days later, she underwent a right subclavian artery aneurysm repair, right brachial and ulnar artery thrombectomy, and first rib resection. Three months later, she demonstrated good neurologic recovery. TOS is an uncommon cause of stroke in children, which may be heralded by upper-extremity symptoms. Interventionalists should be aware of the possibility of vascular anomalies in children; however, this finding does not exclude the possibility of acute stroke intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pediatric Stroke due to Thoracic Outlet Syndrome Treated with Thrombolysis and Thrombectomy: A Case Report

et al. 2022

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“…The mechanism of cerebral embolization associated with the TOS is both poorly understood, and difficult to identify in the initial stages of the development. According to Meumann (2013), it may be due to retrograde propagation of thrombus or transient retrograde flow within the subclavian artery exacerbated by arm abduction [97]. Awareness of a change in symptom reporting by the athlete is an important consideration for future research.…”

Section: Baseballmentioning

confidence: 99%

Stroke and Athletes: A Scoping Review

Doyle‐Baker

Mitchell

Hayden

2021

IJERPH

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Stroke (i.e., cerebrovascular accident) affects one in 10,000 people between the ages of 14 and 45; however, very little is known about the frequency and type of stroke that occurs in athletes. The risk of injury to the neurovascular structures may depend on the type of sport involvement, although, sport-specific incidence rates are not known. Therefore, the goal of our scoping review was to provide some guidance to better inform the development of a context-fit stroke model by summarizing studies on a broad research topic related to stroke or cerebrovascular accident in sport based on a strict athlete definition. We used the guidance of Arksey and O’Malley’s five-stage-process for a scoping review. Databases included MEDLINE(R) Epub Ahead of Print, In-Process & Other Non- Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R), and Embase (OVID databases); CINAHL Plus with Full Text, SportDiscus with Full Text (Ebsco databases); and Scopus. Publication dates were from 1979–2020 across nine different countries resulting in 39 individual cases of stroke with an athlete age range of 14–56 years (95% male). The major inciting event(s) prior to stroke onset were headaches (38.4%), head trauma (30.7%), and neck injury and/or vertebral artery dissection (20.5%). Several sporting activities were represented with American football as the most prevalent (30.7%). In summary, we found that sports with an aspect of impact, collision, or microtrauma can lead to subsequent stroke. These sport-related traumatic events were often difficult to diagnose because of the longer interval before ischemia occurred. Therefore, health care providers should be particularly attuned to the possibility of stroke when evaluating athletes presenting with or without neurological deficit.

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“…Preexisting literature has shown that patients with TOS have developed thromboembolus that travelled retrograded from the subclavian artery to the head and caused stroke, 36,37,38,39,40,41,42 demonstrating the potential for retrograde flow from subclavian to carotid artery in TOS patients. We postulate that the compression imposed on the distal subclavian artery in TOS not only inhibits some blood from entering the brachial artery, but that the obstructed blood reverts toward the head, resulting in, to some extent, continuous TOS-induced cerebrovascular hyperperfusion (CVH).…”

Section: Tos' Effect On Haemodynamics and Its Implicationsmentioning

confidence: 99%

Does thoracic outlet syndrome cause cerebrovascular hyperperfusion? Diagnostic markers for occult craniovascular congestion

Larsen

Galluccio

Chand³

2020

APIC

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Thoracic outlet syndrome (TOS) is known to be associated with diffuse craniological comorbidities (CCM), such as occipital headaches, migraines, vestibular dysfunction, tinnitus and fatigue. Conventionally, these problems have been suggested to be a manifestation of positional vertebrobasilar insufficiency. Angiography tends to be normal in TOS sufferers, however, and doppler ultrasonography of the vertebral artery fails to demonstrate severe flow reduction. TOS is attributed to the brachial plexus and subclavian artery being compressed in the interscalene triangle, costoclavicular or subpectoral passages. The vertebral and carotid arteries arise from subclavian artery proximal to the sites of obstruction in TOS. Numerous reports of resolved CCM post-scalenectomy and first-rib resection, despite lacking vertebral artery impairment, have been documented. TOS CCM, moreover, share many of the symptoms seen in systemic and intracranial hypertension. Reports of subclavian thromboembolus migrating to the head have been documented in incidences of TOS, showing the potential for flow retrogradation. We postulate that the blood prevented from entering the brachium due to distal subclavian compression, retrogrades to the brain via the carotid and vertebral arteries, resulting in craniovascular hyperperfusion and congestion. Abbreviations: Thoracic outlet syndrome: TOS, Vertebral artery: VA, Vertebrobasilar insufficiency: VBI, Cerebrovascular hyperperfusion: CVH, Blood-brain barrier: BBB, Myalgic encephalomyelitis: ME, “Time of flight”: TOF, Citation: Larsen K, Galluccio FC, Chand SK. Does thoracic outlet syndrome cause cerebrovascular hyperperfusion? Diagnostic markers for occult craniovascular congestion. Anaesth pain intensive care 2020;24(1)___ Received – 30 November 2019; Reviewed – 2, 6 February 2019; Accepted – 27 February 2019;

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Thromboembolic stroke associated with thoracic outlet syndrome

Cited by 21 publications

References 24 publications

Pediatric Stroke due to Thoracic Outlet Syndrome Treated with Thrombolysis and Thrombectomy: A Case Report

Pediatric Stroke due to Thoracic Outlet Syndrome Treated with Thrombolysis and Thrombectomy: A Case Report

Stroke and Athletes: A Scoping Review

Does thoracic outlet syndrome cause cerebrovascular hyperperfusion? Diagnostic markers for occult craniovascular congestion

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