[Treatment for recurrent paradoxical brain embolism through the patent foramen ovale]

We report here two patients with recurrent paradoxical brain embolism through the patent foramen ovale(PFO). The TIAs, which occurred frequently under antiplatelet therapy, resolved soon after commencing the anticoagulation therapy. Case 1, a 57-year-old woman, was diagnosed as having lacunar brain infarction and was treated with ticlopidine hydrochloride. Eleven months later, she suffered from frequent TIAs. Anticoagulation therapy was started after the presence of PFO was documented on transesophageal echocardiography(TEE). Thereafter, her TIA disappeared. Case 2 was a 67-year-old man with a history of lacunar brain infarction. Although he was treated with aspirin for 9 months, he showed transient monoplegia in his right leg. His TEE study also revealed the presence of PFO. After the anticoagulation therapy reached the proper level(PT-NR = 2), he never experienced the recurrence of TIA. If the antiplatelet therapy failed to prevent the recurrence of TIA, it is recommended to find out the presence of PFO which is a potential source of paradoxical brain embolism. In such a case, anticoagulation therapy should be instituted.