Paradoxical cerebral embolism: eight cases.
We evaluated eight patients with possible or probable paradoxical cerebral embolism. One patient had a hemispheric transient ischemic attack; the others had infarcts. Ischemic symptoms followed a Valsalva's maneuver in three cases. Others were linked to placement of a Swan-Ganz catheter, deep venous thrombosis and pulmonary embolism, right atrial myxoma, and use of oral contraceptives. Four had no known predisposing conditions. In six patients, contrast echocardiography showed right-to-left shunting. Cardiac catheterization showed a patent foramen ovale in three patients; one had an atrial septal defect. In the clinical setting of otherwise unexplained cerebral embolism in a young patient, paradoxical cerebral embolism should be considered. Contrast echocardiography is a useful screening test for this purpose.
D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000150:complications* / Q000175:diagnosis; D002544:Cerebral Infarction / Q000209:etiology; D003276:Contraceptives, Oral / Q000009:adverse effects; D004452:Echocardiography; D005260:Female; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis / Q000209:etiology*; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male
D003276:Contraceptives, Oral