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Case Reports
. 2021 Dec 15;60(24):3987-3990.
doi: 10.2169/internalmedicine.7024-21. Epub 2021 Jun 26.

Paradoxical Cerebellar Embolism Associated with Platypnea-orthodeoxia Syndrome

Kei-Ichiro Takase  1 , Norihisa Maeda  2 , Shoji Kawakami  3 , Shujiro Inoue  3
Affiliations
Case Reports

Paradoxical Cerebellar Embolism Associated with Platypnea-orthodeoxia Syndrome

Kei-Ichiro Takase et al. Intern Med. .

Abstract

Platypnea-orthodeoxia syndrome is a rare clinical entity characterized by dyspnea and arterial blood deoxygenation in a sitting position. An 89-year-old woman was diagnosed with subacute cerebellar infarction. Her blood oxygen saturation decreased to 88% in a sitting position, resulting in dyspnea. Cardiological thoracic computed tomography revealed an unruptured aortic aneurysm, an enlarged ascending aorta, right atrial compression, and counterclockwise rotation of the heart. An anatomical distortion of the atrial septum induced by these abnormalities directed the atrial venous inflow such that the right-left shunt flow was exacerbated in a sitting position.

Keywords: paradoxical cerebellar embolism; platypnea-orthodeoxia syndrome.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
(A) Diffusion-weighted magnetic resonance imaging, (B) fluid-attenuated inversion recovery imaging, and (C) magnetic resonance angiography in the axial view. A large subacute infarction is seen in the right cerebellar cortex (A, white arrowheads). The right posterior inferior cerebellar artery is occluded (C, white arrow).
Figure 2.
Figure 2.
Enhanced thoracic computed tomography in the (A-C) axial view, (D) coronal view, and (E) sagittal view. Cardiological imaging reveals a 45-mm unruptured aortic aneurysm (A, white arrowheads) and an enlarged ascending aorta (B-E, white arrows). Anatomic dilatation and distortion of the proximal ascending aorta induced by the aneurysm led to right atrial compression (D and E, black arrowheads) and counterclockwise rotation of the heart with distortion of the atrial septum (D, black arrows).
Figure 3.
Figure 3.
Transthoracic echocardiography in the (A) recumbent position and (B) seated position. The images depict the right atrium (white arrowhead), right ventricle (black arrowhead), left atrium (white arrow), and left ventricle (black arrow). (A) Although no microbubbles are observed in the left atrium or ventricle in the recumbent position, (B) many can be seen in the seated position.
See this image and copyright information in PMC

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