Document Detail

Paradoxical brain embolism in an acute stroke.
MedLine Citation:
PMID:  17307200     Owner:  NLM     Status:  MEDLINE    
Paradoxical embolism to the cerebral circulation is often difficult to diagnose clinically. We report a case that illustrates the usefulness of transesophageal echocardiography in the detection of paradoxical embolism. An 84-year-old woman presented with bilateral hemispheric strokes. Despite the presence of atrial fibrillation, clinical suspicion of paradoxical embolism led to further investigation. An underlying lower limb deep venous thrombosis was found, lung scintigraphy showed pulmonary embolism, and a right-to-left shunt was detected using contrast-transcranial Doppler ultrasound even without the Valsalva maneuver. Transesophageal echocardiography confirmed a mobile 4-cm serpiginous thrombus wedged into a patent foramen ovale, extending from the right into the left atria. Multiple imaging modalities were used, allowing rapid diagnosis of paradoxical embolism, with an underlying DVT as the mechanism of stroke. Of all the investigations, visualization with TEE proved crucial in confirming the diagnosis.
Takeshi Iwanaga; Yasuyuki Iguchi; Kensaku Shibazaki; Takeshi Inoue; Kazumi Kimura
Publication Detail:
Type:  Case Reports; Journal Article     Date:  2007-02-20
Journal Detail:
Title:  Journal of the neurological sciences     Volume:  254     ISSN:  0022-510X     ISO Abbreviation:  J. Neurol. Sci.     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-03-06     Completed Date:  2007-05-29     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0375403     Medline TA:  J Neurol Sci     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  102-4     Citation Subset:  IM    
Department of Stroke Medicine, Kawasaki Medical School, Japan.
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MeSH Terms
Aged, 80 and over
Atrial Fibrillation / complications,  physiopathology
Echocardiography, Doppler
Echocardiography, Transesophageal / standards*
Embolism, Paradoxical / etiology*,  physiopathology
Fatal Outcome
Heart Atria / pathology,  physiopathology,  ultrasonography
Heart Septal Defects, Atrial / complications*,  physiopathology,  ultrasonography*
Intracranial Embolism / etiology*,  physiopathology
Predictive Value of Tests
Pulmonary Embolism / complications,  physiopathology,  radionuclide imaging
Radionuclide Imaging
Stroke / etiology*,  physiopathology
Venous Thrombosis / complications*,  physiopathology

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