Description of Event or Problem · 0
THE PATIENT WAS ENROLLED IN THE WATCHMAN HEAL-LAA STUDY ON (B)(6) 2023 WITH PATIENT IDENTIFIER (B)(6). IT WAS REPORTED THAT THE PATIENT EXPERIENCED AN ISCHEMIC STROKE. A LEFT ATRIAL APPENDAGE (LAA) CLOSURE PROCEDURE WAS PERFORMED ON (B)(6) 2023, AND A 24MM WATCHMAN FLX PRO CLOSURE DEVICE WAS IMPLANTED WITH A COMPLETE LAA SEAL AND DEPLOYED DEVICE DIAMETER OF 20 MM. THE PATIENT WAS DISCHARGED THE NEXT DAY ON A MEDICATION REGIME OF ASPIRIN AND RIVAROXABAN. ON (B)(6) 2024, 282 DAYS POST INDEX PROCEDURE, THE PATIENT EXPERIENCED RIGHT SIDED NUMBNESS WHILE AT A GOLF COURSE AND HAD DEVELOPED ACUTE ONSET OF NUMBNESS IN THE RIGHT HIP WHICH SPREAD DOWN THE RIGHT LEG AND IN THE RIGHT ARM WHICH LED TO A FALL. THE NUMBNESS LASTED FOR 15 MINUTES. ON THE SAME DAY, THE PATIENT PRESENTED EMERGENTLY ABOUT THE NUMBNESS IN THE RIGHT LOWER AND UPPER EXTREMITY. THE PATIENT REPORTED THAT THE SYMPTOMS IMPROVED SLOWLY AND DENIED ANY SLURRED SPEECH, LOSS OF CONSCIOUSNESS OR GAIT DISTURBANCES. UPON ARRIVAL, A PHYSICAL AND NEUROLOGICAL EXAMINATION WAS PERFORMED, AND THE PATIENT WAS ALERT WITH NO FOCAL WEAKNESS, NO FACIAL DROP, NO TRAUMA, NO LOSS OF CONSCIOUSNESS AND NIHSS SCORE WAS 0. MOTOR FUNCTION SHOWED THAT THE LOWER AND UPPER EXTREMITIES ARM GRIP WAS WITHOUT ANY DRIFTS AND STRENGTH WAS 5/5 IN ALL THE LOWER AND UPPER EXTREMITY. HOWEVER, THE PATIENT HAD LINGERING WEAKNESS BELOW IN THE KNEE. LAB TESTING WAS PERFORMED, AND PATIENT WAS DEHYDRATED, AND PHYSICIAN SUSPECTED THAT DEHYDRATION WOULD HAVE CAUSED THE REOCCURRENCE OF STROKE (MEDICAL HISTORY (B)(6) 2020). THE PATIENT ALSO HAD ELEVATED BLOOD PRESSURE WHICH WAS TREATED BY ASPIRIN AND STATINS. ELECTROCARDIOGRAM (ECG) WAS PERFORMED WHICH SHOWED SINUS RHYTHM. THERE WAS NO CLEAR EVIDENCE WHETHER THE SYMPTOMS NOTED WERE A RECURRENCE OF PREVIOUS MEDICAL CONDITION OF ISCHEMIA CEREBRAL VASCULAR ACCIDENT OR ACUTE ISCHEMIC STROKE, SO MAGNETIC RESONANCE IMAGING (MRI) WAS RECOMMENDED. ON (B)(6) 2024, A BRAIN MRI WAS COMPLETED WITHOUT CONTRAST AND IMAGING RESULTS SHOWED SMALL ACUTE/SUBACUTE INFARCTS IN THE POSTERIOR LEFT FRONTAL LOBE NEAR THE VERTEX POSSIBLY EMBOLIC IN NATURE, SMALL T2 FLAIR HYPERINTENSITY WITHIN THE LEFT CEREBELLAR HEMISPHERE, POSSIBLY REPRESENTING SUBACUTE INFARCT. THE PATIENT WAS DIAGNOSED WITH ACUTE NEW ISCHEMIC STROKE IN LEFT FRONTAL LOBE. ADDITIONALLY, THE PHYSICIAN WAS CONCERNED ABOUT THE RECURRENCE OF PAROXYSMAL ATRIAL FIBRILLATION OR ARRHYTHMIA WHICH WOULD HAVE LED TO CARDIO EMBOLIC STROKE. ON (B)(6) 2024, PHYSICAL THERAPY EVALUATION WAS PERFORMED AND MOST OF THE SYMPTOMS RESOLVED BUT THE PATIENT HAD SLIGHT SENSORY IMPAIRMENT IN THE RIGHT LOWER EXTREMITY. THE PATIENT AMBULATED WITHOUT ASSISTANCE AND NO FURTHER PHYSICAL THERAPY NEEDED AND RECOMMENDED FOR DISCHARGE. A TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) WAS COMPLETED WITH BUBBLE STUDY WHICH SHOWED NO DEVICE RELATED THROMBUS OR PERI DEVICE LEAK. THERE WAS AN INTRAARTERIAL SHUNT ON TRANSTHORACIC ECHOCARDIOGRAM (TTE) BUBBLE. ON (B)(6) 2024, RIVAROXABAN MEDICATION WAS RESTARTED AND CONTINUED ASPIRIN. THE PATIENT WAS DISCHARGED HOME AND RECOMMENDED TO FOLLOW UP WITH STRUCTURAL HEART AND VALVE CLINIC AND PRIMARY CARE PHYSICIAN IN 1-2 WEEKS.