title: [Brain infarctions caused by paradoxical embolism during long-distance flights].
abstract: METHODS
  Over the period of one year three long-distance airline passengers (aged 21, 63, and 64 years) were admitted to our department because of a first-time acute neurological deficit having occurred during their long-distance flights.
  
  
  METHODS
  In all three cases acute stroke MRI showed embolic cerebral ischemia, and transesophageal echocardiography revealed a persistent foramen ovale (PFO). Venous duplex and compression ultrasonography of the legs showed no signs of thrombosis. Extra- and transcranial Doppler, Holter ECG recording, routine blood analysis and additional tests for thrombophilia (incl. lupus anticoagulans, APC resistance, protein C, S, and AT III) revealed no signs of cardiovascular disease or other stroke causes. Only in case 3 the prothrombin gene G 20210A was found.
  
  
  METHODS
  Ischemic stroke due to paradoxical embolism through a PFO was diagnosed in all three patients. One patient recovered fully within 2 days, one was discharged with a persistent motor deficit and the third patient died subsequently as a result of multiple cerebral infarctions accompanied by massive pulmonary embolism.
  
  
  CONCLUSIONS
  These three cases illustrate that paradoxical embolic stroke is a possible severe complication of long-distance air travel in passengers with a PFO and this should be taken into account when deciding upon individual risk-adjusted prophylactic measures.
authors.affiliation: Klinik für Neurologie, Johann Wolfgang Goethe-Universität Frankfurt am Main. foerch@em.uni-frankfurt.de
authors.forename: C
authors.initials: C
authors.lastname: Foerch
authors.forename: K R
authors.initials: KR
authors.lastname: Kessler
authors.forename: M
authors.initials: M
authors.lastname: Sitzer
mesh_terms: D000328:Adult; D000401:Aircraft; D002545:Brain Ischemia / Q000150:complications* / Q000209:etiology; D002544:Cerebral Infarction / Q000175:diagnosis / Q000209:etiology*; D004374:Ductus Arteriosus, Patent / Q000150:complications*; D019320:Embolism, Paradoxical / Q000150:complications* / Q000209:etiology; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function