Management Dilemma of Pulmonary Embolism Associated with Haemorrhagic Stroke in Low-Income Settings: A Case Report

Management of thromboembolic disease in an acute bleeding circumstance like haemorrhagic stroke is a real challenge in low-income settings. We report a case of a 37-year-old woman who was treated in the neurologic service for a haemorrhagic stroke that occurred one week after a caesarean section. Six weeks after her discharge, she presented signs of bilateral deep vein thrombosis and pulmonary embolism confirmed by venous Doppler ultrasound and a thoracic angiography respectively. Transthoracic cardiac ultrasound showed right ventricular dysfunction with a clot in the right atrium. Considering the high risk of complications due to anticoagulant treatment, surgical treatment and a vena cava filter were proposed. But it could not be performed because it was not accessible. After a multidisciplinary consultation meeting and informed consent of the patient, anticoagulant treatment was the preferred expectation. Three weeks after the beginning of the anticoagulant therapy, the evolution was favourable, and the patient was discharged.