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Neurological Manifestations of Pulmonary Thromboembolism

Neurological Manifestations of Pulmonary Thromboembolism Abstract During en-ntered four cases of fatal pulmonary thromboembolism in which symptoms and signs referable to the nervous system were sufficiently prominent to mask the true nature of the underlying disease. An analysis of these cases revealed certain clues that might have led to the correct premortem diagnosis. The purpose of this report is to emphasize those clues and to review the neurological manifestations of pulmonary thromboembolism. Report of Cases Case —This 61-year-old man was well until he fainted while carrying a beer cooler to his car. Upon regaining consciousness, he noticed weakness in his right arm, frontal headache, and pain in the right side of the chest, all of which subsided within a few hours. He remained asymptomatic until three days later when he fainted while eating breakfast. His private physician found him to have "low blood pressure" and mental confusion and referred him for further evaluation and therapy.On References 1. Hussey, H., and Katz, S.: Pulmonary Embolism , GP 12:59-68 ( (Aug) ) 1955. 2. Case Records of the Massachusetts General Hospital , New Eng J Med 268:371-378 ( (Feb 14) ) 1963.Crossref 3. Hamilton, M., and Thompson, E.N.: Unusual Manifestations of Pulmonary Embolic Disease , Postgrad Med J 49:348-353 ( (June) ) 1963.Crossref 4. Miller, R., and Berry, J.B.: Pulmonary Infarction: A Frequently Missed Diagnosis , Amer J Med Sci 222:197-206 ( (Aug) ) 1951.Crossref 5. Roth, I.R.: Differential Diagnostic Problems in Acute Pulmonary Embolization , Amer J Med 4:493-502 ( (April) ) 1948.Crossref 6. Sagall, E.L.; Barnstein, J.; and Wolff, L.: Clinical Syndrome in Patients With Pulmonary Embolism , Arch Intern Med 76:234-238 ( (Oct) ) 1945.Crossref 7. Israel, H.L., and Goldstein, F.: The Varied Clinical Manifestations of Pulmonary Embolism , Ann Intern Med 47:202-226 ( (Aug) ) 1957.Crossref 8. Hickam, J.B., and Sieker, H.O.: Pulmonary Embolism and Infarction , DM ( (Jan) ) 1959, pp 1-36. 9. Fowler, E.F., and Bollinger, J.A.: Pulmonary Embolism: A Clinical Study of Ninety-Seven Fatal Cases , Surgery 36:650-663 ( (Sept) ) 1954. 10. Ehrner, L.; Garlind, T.; and Linderholm, H.: Chronic Cor Pulmonale Following Thromboembolism: A Clinical and Pathophysiological Study of Three Cases , Acta Med Scand 164:279-297, 1959.Crossref 11. Ramirez, L.M.: Thromboembolic Disease in Adolescence , JAMA 170:1808-1811 ( (Aug 8) ) 1959.Crossref 12. Costeas, F.; Raftopoulos, J.; and Liarakos, E.: Cerebral Stroke Immediately Following Pulmonary Embolism , Angiology 16:355-357 ( (June) ) 1965.Crossref 13. Krause, S., and Silverblatt, M.: Pulmonary Embolism: A Review With Emphasis on Clinical and Electrocardiographic Diagnosis , Arch Intern Med 96:19-25 ( (July) ) 1955.Crossref 14. Gerber, I.E.: Pulmonary Embolism in the Aged: Unusual Clinical Features , Geriatrics 19:3-10 ( (Jan) ) 1964. 15. Alexander, J.K., et al: Cardiorespiratory Function in Patients With Acute Pulmonary Thromboembolism Demonstrated Angiographically , Clin Res 13:346 ( (April) ) 1965. 16. Adams, J.H., et al: The Effects of Systemic Hypotension Upon the Human Brain: Clinical and Neuropathological Observations in 11 Cases , Brain 89:235-268 ( (June) ) 1966.Crossref 17. Wallach, R.; Pomerantz, N.; and DiMaio, D.: Emboli Arising in the Lungs , Arch Intern Med 99:142-146 ( (Jan) ) 1957.Crossref 18. Clinicopathologic Conference , New Physician 12:521-525 ( (Dec) ) 1963. 19. Gorham, L.W.: A Study of Pulmonary Embolism: Part I. A Clinicopathological Investigation of 100 Cases of Massive Embolism of the Pulmonary Artery; Diagnosis by Physical Signs and Differentiation From Acute Myocardial Infarction , Arch Intern Med 108:8-22 ( (July) ) 1961.Crossref 20. Surawicz, B.: Electrocardiographic Pattern of Cerebrovascular Accident , JAMA 197:913-914 ( (Sept 12) ) 1966.Crossref 21. Richards, P.: Pulmonary Oedema and Intracranial Lesions , Brit Med J 2:83-86 ( (July 13) ) 1963.Crossref 22. Hirst, A.E., Jr.; Johns, V.J., Jr.; and Kime, S.W., Jr.: Dissecting Aneurysm of the Aorta: A Review of 505 Cases , Medicine 37:217-279 ( (Sept) ) 1958.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Neurological Manifestations of Pulmonary Thromboembolism

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References (27)

Publisher
American Medical Association
Copyright
Copyright © 1967 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1967.00300010035006
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Abstract

Abstract During en-ntered four cases of fatal pulmonary thromboembolism in which symptoms and signs referable to the nervous system were sufficiently prominent to mask the true nature of the underlying disease. An analysis of these cases revealed certain clues that might have led to the correct premortem diagnosis. The purpose of this report is to emphasize those clues and to review the neurological manifestations of pulmonary thromboembolism. Report of Cases Case —This 61-year-old man was well until he fainted while carrying a beer cooler to his car. Upon regaining consciousness, he noticed weakness in his right arm, frontal headache, and pain in the right side of the chest, all of which subsided within a few hours. He remained asymptomatic until three days later when he fainted while eating breakfast. His private physician found him to have "low blood pressure" and mental confusion and referred him for further evaluation and therapy.On References 1. Hussey, H., and Katz, S.: Pulmonary Embolism , GP 12:59-68 ( (Aug) ) 1955. 2. Case Records of the Massachusetts General Hospital , New Eng J Med 268:371-378 ( (Feb 14) ) 1963.Crossref 3. Hamilton, M., and Thompson, E.N.: Unusual Manifestations of Pulmonary Embolic Disease , Postgrad Med J 49:348-353 ( (June) ) 1963.Crossref 4. Miller, R., and Berry, J.B.: Pulmonary Infarction: A Frequently Missed Diagnosis , Amer J Med Sci 222:197-206 ( (Aug) ) 1951.Crossref 5. Roth, I.R.: Differential Diagnostic Problems in Acute Pulmonary Embolization , Amer J Med 4:493-502 ( (April) ) 1948.Crossref 6. Sagall, E.L.; Barnstein, J.; and Wolff, L.: Clinical Syndrome in Patients With Pulmonary Embolism , Arch Intern Med 76:234-238 ( (Oct) ) 1945.Crossref 7. Israel, H.L., and Goldstein, F.: The Varied Clinical Manifestations of Pulmonary Embolism , Ann Intern Med 47:202-226 ( (Aug) ) 1957.Crossref 8. Hickam, J.B., and Sieker, H.O.: Pulmonary Embolism and Infarction , DM ( (Jan) ) 1959, pp 1-36. 9. Fowler, E.F., and Bollinger, J.A.: Pulmonary Embolism: A Clinical Study of Ninety-Seven Fatal Cases , Surgery 36:650-663 ( (Sept) ) 1954. 10. Ehrner, L.; Garlind, T.; and Linderholm, H.: Chronic Cor Pulmonale Following Thromboembolism: A Clinical and Pathophysiological Study of Three Cases , Acta Med Scand 164:279-297, 1959.Crossref 11. Ramirez, L.M.: Thromboembolic Disease in Adolescence , JAMA 170:1808-1811 ( (Aug 8) ) 1959.Crossref 12. Costeas, F.; Raftopoulos, J.; and Liarakos, E.: Cerebral Stroke Immediately Following Pulmonary Embolism , Angiology 16:355-357 ( (June) ) 1965.Crossref 13. Krause, S., and Silverblatt, M.: Pulmonary Embolism: A Review With Emphasis on Clinical and Electrocardiographic Diagnosis , Arch Intern Med 96:19-25 ( (July) ) 1955.Crossref 14. Gerber, I.E.: Pulmonary Embolism in the Aged: Unusual Clinical Features , Geriatrics 19:3-10 ( (Jan) ) 1964. 15. Alexander, J.K., et al: Cardiorespiratory Function in Patients With Acute Pulmonary Thromboembolism Demonstrated Angiographically , Clin Res 13:346 ( (April) ) 1965. 16. Adams, J.H., et al: The Effects of Systemic Hypotension Upon the Human Brain: Clinical and Neuropathological Observations in 11 Cases , Brain 89:235-268 ( (June) ) 1966.Crossref 17. Wallach, R.; Pomerantz, N.; and DiMaio, D.: Emboli Arising in the Lungs , Arch Intern Med 99:142-146 ( (Jan) ) 1957.Crossref 18. Clinicopathologic Conference , New Physician 12:521-525 ( (Dec) ) 1963. 19. Gorham, L.W.: A Study of Pulmonary Embolism: Part I. A Clinicopathological Investigation of 100 Cases of Massive Embolism of the Pulmonary Artery; Diagnosis by Physical Signs and Differentiation From Acute Myocardial Infarction , Arch Intern Med 108:8-22 ( (July) ) 1961.Crossref 20. Surawicz, B.: Electrocardiographic Pattern of Cerebrovascular Accident , JAMA 197:913-914 ( (Sept 12) ) 1966.Crossref 21. Richards, P.: Pulmonary Oedema and Intracranial Lesions , Brit Med J 2:83-86 ( (July 13) ) 1963.Crossref 22. Hirst, A.E., Jr.; Johns, V.J., Jr.; and Kime, S.W., Jr.: Dissecting Aneurysm of the Aorta: A Review of 505 Cases , Medicine 37:217-279 ( (Sept) ) 1958.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Jul 1, 1967

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