Bihemispheric Paradoxical Cerebral Embolism in a Patient with Pulmonary Thromboembolism and Presumptive Fistula Right-to-Left Shunt.
We report a case of a bihemispheric paradoxical cerebral embolism in a patient with pulmonary thromboembolism and presumptive pulmonary arteriovenous fistula. The echocardiogram showed no intracardiac shunt, and the transcranial Doppler (TCD) revealed spontaneous microembolic signals in the middle cerebral arteries (MCAs), and late passage of a higher number of microembolic signals in the MCAs, compatible with right-to-left shunt (RLS). The TCD and the echocardiogram were useful for identifying the RLS when rapid neurological deterioration occurred.
Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil.
Silméia Garcia
SG
Zanati Bazan
Department of Neurology, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil.
Gabriel Pereira
GP
Braga
Department of Neurology, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil. Electronic address: gluvizutto@fmb.unesp.br.
Gustavo José
GJ
Luvizutto
Department of Tropical Diseases and Diagnostic Imaging, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil.
André Petean
AP
Trindade
Department of Neuroscience and Behavior, Ribeirão Preto Medical School-USP, São Paulo State University, São Paulo, Brazil.
Octávio Marques
OM
Pontes-Neto
Department of Neurology, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil.
Rodrigo
R
Bazan
D000368:Aged; D001164:Arteriovenous Fistula / Q000150:complications* / Q000000981:diagnostic imaging; D002533:Cerebral Angiography / Q000379:methods; D000072226:Computed Tomography Angiography; D018450:Disease Progression; D004452:Echocardiography; D019320:Embolism, Paradoxical / Q000000981:diagnostic imaging / Q000209:etiology*; D017809:Fatal Outcome; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000209:etiology*; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging; D013997:Time Factors; D017585:Ultrasonography, Doppler, Transcranial
Stroke; echocardiogram; paradoxical embolism; transcranial Doppler