Pulmonary multifocal arteriovenous malformations lead to ischemic stroke in young adults: a case report and literature review

In recent years, the incidence of ischemic stroke in young people has gradually increased. The etiology and risk factors of young patients with ischemic stroke are complex, including migraine with aura, inherited thrombophilias, hyperhomocysteinemia, cardiovascular risk factors and malignancy. Pulmonary arteriovenous malformation (PAVM) is a rare cause of ischemic stroke in young people, which can easily be misdiagnosed and missed due to the lack of specific biomarkers. In this case report, we described a 17-year-old stroke patient who was admitted to hospital due to sudden speech failure accompanied by weakness of the right limb, and was diagnosed with cerebral embolism in the emergency department. After mechanical thrombectomy, the blood vessels were completely recanalized and the symptoms of nerve defects disappeared. Subsequent chest CT examination revealed pulmonary vascular malformations and further pulmonary angiography revealed multiple PAVMs in the lungs. Furthermore, spring coil embolization treatment was performed on 2 PAVMs with an inflow greater than 2 mm. Three months later, enhanced chest CT reexamination showed no recanalization of the malformed vessels at the pulmonary embolism site. Therefore, PAVM should be further not excluded for young stroke patients with unknown causes to avoid misdiagnosis and missed diagnosis, interventional embolization is the best treatment method after diagnosis.