The successful surgical treatment of a paradoxical embolus to the carotid bifurcation.
Paradoxical embolism is a rare cause of ischemic stroke. We report the case of a 67-year-old man who had a saddle embolus to the carotid bifurcation successfully treated with emergency embolectomy. Transesophageal echocardiogram revealed a large patent foramen ovale and an easily demonstrable right-to-left shunt. Subsequent investigations revealed proximal deep venous thrombosis in the left femoral and popliteal veins and multiple pulmonary emboli. Long-term anticoagulation was instituted for the diagnosis of paradoxical embolism. The patient's recovery was uneventful, and he remained neurologically intact. A literature review emphasizes the role of transesophageal echocardiography and suggests that paradoxical embolism may be a more common cause of stroke than previously thought.
McKinney
W B
WB
Department of Surgery, Mercer University School of Medicine, and The Medical Center of Central Georgia, Macon, USA.
O'Hara
W
W
Sreeram
K
K
Hudson
J A
JA
Solis
M
M
D000368:Aged; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D017128:Embolectomy; D019320:Embolism, Paradoxical / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005268:Femoral Vein / Q000000981:diagnostic imaging; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D011152:Popliteal Vein / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging; D020246:Venous Thrombosis / Q000150:complications / Q000000981:diagnostic imaging