title: Abundance of microembolic signals detected by transcranial doppler ultrasound in a patient with Eisenmenger's syndrome.
abstract: BACKGROUND
  Clinically silent circulating microemboli can be detected by transcranial Doppler sonography.
  
  
  METHODS
  We report the case of a 45-year-old man with congenital cyanotic heart disease, elevated haematocrit, low platelet count and decreased protein C and protein S activity. Before and following several haemodilutions, we performed 5 1-hour transcranial Doppler recordings from one or both middle cerebral arteries (MCAs) on different days. The number of microembolic signals per hour varied from 54 to 134. During the bilateral recording, the microemboli occurred on both sides (55 in the right and 45 in the left MCA, respectively). There was no relation to red blood cell count, platelet count, the spontaneously lowered prothrombin time or the spontaneously prolonged activated partial thromboplastin time.
  
  
  CONCLUSIONS
  The origin of the large number of microembolic signals found in this patient remains unclear, but may be presumed in the intra-abdominal or crural venous system.
authors.affiliation: Department of Neurology, University of Münster, Germany.
authors.forename: D W
authors.initials: DW
authors.lastname: Droste
authors.forename: M A
authors.initials: MA
authors.lastname: Ritter
authors.forename: G
authors.initials: G
authors.lastname: Mönnig
authors.forename: V
authors.initials: V
authors.lastname: Kemény
authors.forename: G
authors.initials: G
authors.lastname: Breithardt
authors.forename: E B
authors.initials: EB
authors.lastname: Ringelstein
mesh_terms: D004541:Eisenmenger Complex / Q000000981:diagnostic imaging*; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging*; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery; D012307:Risk Factors; D017585:Ultrasonography, Doppler, Transcranial