Comparison of transcranial contrast Doppler sonography and transesophageal contrast echocardiography for the detection of patent foramen ovale in young stroke patients.
The prevalence of a patent foramen ovale was assessed by simultaneously performing transesophageal contrast echocardiography and transcranial contrast Doppler sonography (TCD) in 137 subjects (mean age 36 years) with stroke of unclarified etiology (n = 41), clarified etiology (n = 33), and in normal subjects (n = 63; mean age 32 years). Patent foramen ovale was found significantly more often in patients with unclarified than clarified strokes or in normal subjects (66% vs 33%, or 43%). Massive paradoxical embolism through a patent foramen ovale, identified by TCD, occurred significantly (p < 0.01) more often in patients with unclarified (64%) than clarified (27%) strokes or in normal subjects (3%). However, minimal shunts were typical in normal subjects (79%). Patent foramen ovale was detected indirectly by TCD when calculated on the basis of transesophageal contrast echocardiographic findings (sensitivity 89%, specificity 92%). Thus, TCD reliably detects paradoxical cerebral embolism through a patent foramen ovale, and provides important additional information for evaluating its clinical relevance by semi-quantification of embolic contrast material.
Job
F P
FP
Medical Clinic I, Rheinisch-Westfälischen Technischen Hochschule, Aächen, Germany.
Ringelstein
E B
EB
Grafen
Y
Y
Flachskampf
F A
FA
Doherty
C
C
Stockmanns
A
A
Hanrath
P
P
D000328:Adult; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D003287:Contrast Media; D017548:Echocardiography, Transesophageal; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000000981:diagnostic imaging*; D008297:Male; D015995:Prevalence; D012680:Sensitivity and Specificity; D017585:Ultrasonography, Doppler, Transcranial
D003287:Contrast Media