Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of focal neurological deficits (e.g., hemiparesis, dysarthria) concurrent with symptoms of venous thromboembolism (e.g., pleuritic chest pain, dyspnea, or lower extremity swelling). History significant for recent DVT or immobilization. No history of atrial fibrillation or valvular disease. Clinical suspicion for right-to-left shunt (PFO/ASD) facilitating paradoxical embolization.
Clinical Examination Findings
Vitals: Tachycardic, tachypneic, O2 saturation may be compromised. Neuro: Focal deficits consistent with ischemic stroke (NIHSS score: [insert]). Cardiac: Regular rhythm, possible fixed split S2 (if ASD). Pulmonary: Clear to auscultation or diminished breath sounds. Extremities: Unilateral calf tenderness, edema, or positive Homanโs sign suggestive of DVT.
Treatment Protocol
Immediate stabilization of airway, breathing, and circulation. Initiate anticoagulation therapy (e.g., LMWH or heparin drip) pending hematology/neurology consultation. Consider mechanical thrombectomy for large vessel occlusion. Echocardiography (TTE/TEE with bubble study) to confirm PFO/ASD. Long-term management: PFO closure device, antiplatelet therapy, or lifelong anticoagulation as indicated.