Document Detail

Paradoxical embolization: a potential cause of cerebral damage in Alzheimer's disease?
MedLine Citation:
PMID:  16945222     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: There are considerable overlaps between vascular dementia and Alzheimer's disease (AD), with a suggestion that cerebrovascular disease (CVD) contributes to the neurodegenerative pathology of AD. Paradoxical embolization of venous emboli into the systemic circulation through a venous to arterial circulation shunt (v-aCS), the most commonly a patent foramen ovale (PFO), is known to cause cryptogenic stroke in younger people. We reviewed the potential role of paradoxical embolization in AD. METHODS: A review of the literature on paradoxical embolization in neurological disorders and techniques to detect v-aCS and PFO, supplemented by data from our own studies. RESULTS: Before our research, the role of paradoxical embolism in dementia had not been studied. The potential role of embolization in cerebral damage was highlighted by studies in patients undergoing coronary artery bypass or carotid surgery. Paradoxical embolization was found to occur in patients with cryptogenic stroke, migraine, decompression sickles and during hip surgery. The methods for detecting v-aCS or PFO had not been standardized. We found 'significant' v-aCS (equivalent to PFO) in 32% of AD patients compared with 22% of controls, but the study was not sufficiently powered to test the statistic significance of this difference. In AD, there was evidence of an association between 'significant' v-aCS and the severity of white matter hyperintensities on magnetic resonance imaging (MRI). CONCLUSION: Paradoxical embolization through a v-aCS may be a potentially preventable or treatable cause of CVD in AD.
N Purandare; R C Oude Voshaar; A Burns; U M Velupandian; C McCollum
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Neurological research     Volume:  28     ISSN:  0161-6412     ISO Abbreviation:  Neurol. Res.     Publication Date:  2006 Sep 
Date Detail:
Created Date:  2006-09-01     Completed Date:  2006-10-19     Revised Date:  2007-08-13    
Medline Journal Info:
Nlm Unique ID:  7905298     Medline TA:  Neurol Res     Country:  England    
Other Details:
Languages:  eng     Pagination:  679-84     Citation Subset:  IM    
Division of Psychiatry, Education and Research Center, Wythenshawe Hospital, Wythenshawe, Manchester, M23 9LT, UK.
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MeSH Terms
Alzheimer Disease / etiology*,  physiopathology*,  ultrasonography
Cerebrovascular Circulation
Cerebrovascular Disorders / etiology,  physiopathology,  ultrasonography
Embolism, Paradoxical / complications*,  physiopathology*,  ultrasonography
Grant Support
//Wellcome Trust

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