Cerebellar Syndrome as a Presentation of Pulmonary Hypertension

Pablo Ruiz-Sada*, María-Jesús Iguzquiza-Pellejero, María-José Esquillor-Rodrigo and Lara Palacios-García

Cerebellar Syndrome as a Presentation of Pulmonary Hypertension

A 56-year-old woman with a past history of seronegative rheumatoid arthritis treated with
leflunomide came to the Accident and Emergency unit complaining of one month of
shortness of breath, grade III New-York Heart Association, and 48 hours of dysarthria
and gait and postural instability causing several falls.

Upon physical examination, we found a wide-based gait with negative Romberg test,
dysarthria without language impairment and  heart murmurs: a systolic one around
the tricuspid area and a holosystolic mitral-area localized.

Computed-tomography scan showed a sub-acute infarct in the left superior
cerebellar artery region. Laboratory results revealed an acute respiratory
failure and an electrocardiogram the following findings.

The patient underwent full assessment and an angio-CT scan was performed to rule
out pulmonary embolism and interstitial lung disease. As well as the angio-CT scan,
a supra aortic trunks doppler scan was normal.

Transthoracic echocardiogram, however, estimated a systolic pressure in pulmonary
artery of 128 mmHg and the microbubble injection

technique, the presence of bubbles in the atrium and left ventricle
in the 1st 3 beats after opacification of the right cavities. These
highly suggestive findings of patent foramen ovale were
confirmed by the right heart catheterization and defined as a PFO
type interatrial communication.

A lack of response to the acute vasodilator test with epoprostenol
and a right to left communication with a continuous shunt were observed.

We closed the anatomic defect and started her on ambrisentan, tadalafil, aspirin
and optimized her underlying rheumatic condition treatment.

Intern Med Open J. 2016; 1(1): 11-12.doi: 10.17140/IMOJ-1-103