Paradoxical Embolisomal Posterior Choroidal Artery Stroke

Paradoxical Embolisomal Posterior Choroidal Artery Stroke, though sounding complicated, is a condition we will break down in simple terms. This article aims to provide you with clear explanations, causes, symptoms, diagnostic tests, treatments, drugs, and surgical options in easy-to-understand language.

This condition, often called PEPCA Stroke, occurs when a small clot or debris travels to a specific area in the brain called the posterior choroidal artery. The paradoxical part comes from the fact that the clot usually originates from somewhere else in the body.

Types:

  1. Ischemic Stroke: The Most Common Type

    In PEPCA Stroke, the most common type is ischemic, which means it’s caused by a blocked blood vessel in the posterior choroidal artery.

  2. Hemorrhagic Stroke: Less Common but More Severe

    This type occurs when there is bleeding in the posterior choroidal artery. It’s rarer but can be more severe.

Causes:

  1. Blood Clots: The Usual Culprit
    • Blood clots in the heart or other parts of the body can break off and travel to the posterior choroidal artery.
    • Clots can form due to conditions like atrial fibrillation, deep vein thrombosis, or atherosclerosis.
  2. Fat Deposits: Another Trigger
    • Fat deposits in the bloodstream, called plaques, can also dislodge and cause a stroke.
  4. Paradoxical Embolism: The Unique Twist
    • Sometimes, a clot can pass through a hole in the heart (known as a patent foramen ovale) and reach the brain, causing a paradoxical embolic stroke.
  5. Other Causes: Rare But Possible
    • Conditions like vasculitis, certain infections, or even trauma to the head can rarely lead to PEPCA Stroke.

Symptoms:

  1. Sudden Weakness: A Telltale Sign
    • One of the most common symptoms is sudden weakness, often on one side of the body.
  2. Trouble Speaking: Difficulty Expressing Words
    • Difficulty speaking or understanding speech can occur.
  3. Confusion: Mental Disarray
    • Confusion, disorientation, or trouble understanding what’s happening may be experienced.
  4. Vision Problems: Blurry or Loss of Vision
    • Blurry vision or even loss of vision in one eye might happen.
  5. Severe Headache: An Unusual Head Pain
    • A severe headache, sometimes described as the “worst ever,” could be a symptom.
  6. Dizziness and Balance Issues: Difficulty Staying Upright
    • Dizziness, loss of balance, or trouble walking may occur.
  7. Nausea and Vomiting: Upset Stomach
    • Nausea and vomiting can accompany other symptoms.
  8. Facial Droop: One Side Appears Different
    • One side of the face may droop, making it hard to smile.
  9. Loss of Coordination: Difficulty Controlling Movements
    • Loss of coordination and fine motor skills might be noticed.
  10. Numbness: Tingling or Lack of Sensation
    • Numbness or tingling, often on one side, can occur.
  11. Loss of Consciousness: Rare but Possible
    • In severe cases, loss of consciousness or even a coma may happen.
  13. Difficulty Swallowing: Trouble Eating or Drinking
    • Difficulty in swallowing can be a sign of a PEPCA Stroke.
  14. Behavior Changes: Altered Emotions or Actions
    • Unusual behavior changes, like sudden mood swings, can occur.

Diagnostic Tests:

  1. CT Scan: A Quick Look Inside
    • A CT scan of the brain can show if there’s bleeding or a blockage.
  2. MRI: Detailed Brain Images
    • MRI scans provide more detailed images of the brain’s structures.
  3. Ultrasound: Assessing Blood Flow
    • An ultrasound of the carotid arteries can check for blockages in the neck.
  4. Electrocardiogram (ECG or EKG): Heart Rhythm Check
    • An ECG monitors the heart’s electrical activity, searching for irregularities.
  5. Holter Monitor: Continuous Heart Monitoring
    • A Holter monitor records heart activity over 24-48 hours, useful for detecting intermittent issues.
  6. Transesophageal Echocardiogram (TEE): Heart Structure Assessment
    • TEE uses a special probe down the throat to get detailed images of the heart and check for holes like a patent foramen ovale.
  8. Blood Tests: Identifying Clotting Disorders
    • Blood tests can identify clotting disorders or other underlying conditions.
  9. Cerebral Angiography: Detailed Brain Blood Vessel Imaging
    • This test involves injecting dye into the blood vessels to get a closer look at the arteries in the brain.
  10. Lumbar Puncture: Collecting Spinal Fluid
    • In some cases, a lumbar puncture might be done to rule out other causes.
  11. Neurological Examination: Assessing Brain Function
    • A thorough neurological exam helps determine the extent of brain damage.

Treatments:

  1. Clot-Busting Medication: A Lifesaver
    • Clot-busting drugs like tPA can be administered if the stroke is caused by a clot, but they must be given within a few hours of symptom onset.
  2. Antiplatelet Medications: Preventing Clots
    • Medications like aspirin can prevent further clot formation.
  4. Anticoagulants: Blood Thinners
    • Anticoagulants like warfarin or newer oral anticoagulants help prevent clot formation.
  5. Statins: Managing Cholesterol
    • Statins can be prescribed to control cholesterol levels and reduce the risk of future strokes.
  6. Blood Pressure Medications: Managing Hypertension
    • Medications to lower blood pressure are often prescribed to reduce stroke risk.
  7. Surgery to Remove Clots: Thrombectomy
    • In some cases, a specialized procedure called thrombectomy can physically remove the clot.
  8. Closure of Patent Foramen Ovale (PFO): Preventing Recurrence
    • If a PFO is found, it can be closed surgically to prevent future paradoxical embolisms.
  9. Rehabilitation: Regaining Function
    • Physical, occupational, and speech therapy can help patients regain lost function.
  10. Lifestyle Changes: Preventing Recurrence
    • Healthy lifestyle choices, such as quitting smoking, managing weight, and exercising, can reduce the risk of another stroke.
  11. Emotional Support: Dealing with Mental Health
    • Emotional support and counseling are crucial for both patients and their families.

Drugs:

  1. Aspirin: Prevents Clots
    • Aspirin is a common blood-thinning medication that helps prevent clots.
  3. Clopidogrel (Plavix): Antiplatelet Medication
    • Clopidogrel is another antiplatelet drug used to prevent clots.
  4. Warfarin (Coumadin): Anticoagulant
    • Warfarin is an older anticoagulant that requires regular monitoring of blood levels.
  5. Rivaroxaban (Xarelto): Oral Anticoagulant
    • Rivaroxaban is a newer oral anticoagulant that doesn’t require frequent blood tests.
  6. Atorvastatin (Lipitor): Cholesterol Medication
    • Atorvastatin is a statin medication that helps lower cholesterol levels.
  7. Lisinopril (Prinivil, Zestril): Blood Pressure Medication
    • Lisinopril is a common medication to lower high blood pressure.
  8. Tissue Plasminogen Activator (tPA): Clot Buster
    • tPA is a powerful medication used to break down clots in emergency situations.
  9. Ezetimibe (Zetia): Cholesterol Absorption Inhibitor
    • Ezetimibe reduces the absorption of cholesterol from the digestive tract.
  10. Metoprolol (Lopressor): Beta-Blocker for Blood Pressure
    • Metoprolol is a beta-blocker often prescribed to manage blood pressure.
  11. Omeprazole (Prilosec): Gastric Protection
    • Omeprazole is used to protect the stomach lining when taking certain blood-thinning medications.

Surgery:

  1. Thrombectomy: Removing Clots
    • Thrombectomy is a surgical procedure to physically remove clots from blood vessels.
  3. Closure of Patent Foramen Ovale (PFO): Preventing Recurrence
    • Surgical closure of a PFO can reduce the risk of future paradoxical embolisms.
  4. Carotid Endarterectomy: Plaque Removal
    • This surgery involves removing plaques from the carotid artery to prevent future strokes.
  5. Angioplasty and Stenting: Opening Blocked Arteries
    • Angioplasty uses a balloon to open blocked arteries, and stents can keep them open.
  6. Craniotomy: Brain Surgery
    • In severe cases, a craniotomy may be necessary to remove bleeding or damaged brain tissue.

Conclusion:

PEPCA Stroke might be a mouthful, but understanding it in simple terms is essential. Recognizing the causes, symptoms, diagnostic tests, and treatment options can help you or your loved ones if you ever face this condition. Always consult a healthcare professional for proper guidance and treatment tailored to your specific situation.

 

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. Thank you for giving your valuable time to read the article.

  1. https://www.ncbi.nlm.nih.gov/books/NBK532297/
  2. https://www.ncbi.nlm.nih.gov/books/NBK549894/
  3. https://www.ncbi.nlm.nih.gov/books/NBK526002/
  4. https://www.ncbi.nlm.nih.gov/books/NBK538474/
  5. https://www.ncbi.nlm.nih.gov/books/NBK53086/
  6. https://medlineplus.gov/skinconditions.html
  7. https://www.aad.org/about/burden-of-skin-disease
  8. https://www.usa.gov/federal-agencies/national-institute-of-arthritis-musculoskeletal-and-skin-diseases
  9. https://www.cdc.gov/niosh/topics/skin/default.html
  10. https://www.skincancer.org/
  11. https://illnesshacker.com/
  12. https://endinglines.com/
  13. https://www.jaad.org/
  14. https://www.psoriasis.org/about-psoriasis/
  15. https://books.google.com/books?
  16. https://www.niams.nih.gov/health-topics/skin-diseases
  17. https://cms.centerwatch.com/directories/1067-fda-approved-drugs/topic/292-skin-infections-disorders
  18. https://www.fda.gov/files/drugs/published/Acute-Bacterial-Skin-and-Skin-Structure-Infections—Developing-Drugs-for-Treatment.pdf
  19. https://dermnetnz.org/topics
  20. https://www.aaaai.org/conditions-treatments/allergies/skin-allergy
  21. https://www.sciencedirect.com/topics/medicine-and-dentistry/occupational-skin-disease
  22. https://aafa.org/allergies/allergy-symptoms/skin-allergies/
  23. https://www.nibib.nih.gov/
  24. https://rxharun.com/rxharun/rxharun/article-types/skin-care-beauty/skin-diseases-types-symptoms-treatment/
  25. https://www.nei.nih.gov/
  26. https://en.wikipedia.org/wiki/List_of_skin_conditions
  27. https://en.wikipedia.org/?title=List_of_skin_diseases&redirect=no
  28. https://en.wikipedia.org/wiki/Skin_condition
  29. https://oxfordtreatment.com/
  30. https://www.nidcd.nih.gov/health/
  31. https://consumer.ftc.gov/articles/w
  32. https://www.nccih.nih.gov/health
  33. https://catalog.ninds.nih.gov/
  34. https://www.aarda.org/diseaselist/
  35. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets
  36. https://www.nibib.nih.gov/
  37. https://www.nia.nih.gov/health/topics
  38. https://www.nichd.nih.gov/
  39. https://www.nimh.nih.gov/health/topics
  40. https://www.nichd.nih.gov/
  41. https://www.niehs.nih.gov
  42. https://www.nimhd.nih.gov/
  43. https://www.nhlbi.nih.gov/health-topics
  44. https://obssr.od.nih.gov/
  45. https://www.nichd.nih.gov/health/topics
  46. https://rarediseases.info.nih.gov/diseases
  47. https://beta.rarediseases.info.nih.gov/diseases
  48. https://orwh.od.nih.gov/

References