QuestionSBA
QuestionChoice
Embolisation to the lungs is a recognised complication of a DVT. This results in a pulmonary embolism, causing symptoms such as shortness of breath and pleuritic chest pain. However, this would not account for the patient's facial droop or slurred speech.
10007904
e
Embolism of the DVT to the lungs
QuestionChoice
This is a possible cause of a haemorrhagic, rather than ischaemic stroke. Although similar symptoms may result, the CT findings rule this out as an underlying diagnosis.
10007903
d
A ruptured berry aneurysm in the brain
QuestionChoice
No, this is not the correct answer. A DVT would not be expected to have this effect on venous return.
10007902
c
Reduced perfusion of the brain due to reduced venous return to the heart
QuestionChoice
Yes, this is the most likely answer. The DVT has embolised to reach the right side of the heart. This emboli has then passed through a structural defect in this patient's atrial septum known as a patent foramen ovale (PFO). Essentially this emboli has bypassed the lungs to reach the systemic circulation and has occluded a vessel within the cerebral circulation, resulting in an ischaemic stroke. This process is known as a paradoxical emboli.

The PFO is an embryological defect whereby the foramen ovale of the atrial septum fails to fuse to become the fossa ovalis. They can be asymptomatic, and therefore pass undetected, in adults. It can lead to a paradoxical emboli following actions such as coughing or lifting heavy objects.
10007900
a
Embolism of the DVT which passed through a patent foramen ovale
QuestionChoice
No, this is not the correct answer. It is extremely uncommon for an arteriovenous anastomosis to exist that allows direct passage of a DVT to the brain.
10007901
b
Embolism of the DVT which bypassed the lungs via an arteriovenous anastomoses
Concept
Chapter
2693
4629
Deep Vein Thrombosis (DVT)
Topic
161
Emergency Medicine
14127
A 50-year-old man presents to A&E with severe right leg pain. On examination, his right leg is visibly swollen in comparison to the left. His observations are all within normal range.

The patient's D-dimer is found to be elevated. He undergoes an ultrasound doppler, which identifies a right sided deep vein thrombosis (DVT).

The following day, he is noted to have a new unilateral facial droop and some slurred speech. An urgent CT head reveals an ischaemic stroke.

Which of the following is the most likely explanation for the patient's deterioration?
a