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[Paradoxical embolism: an unusual cause of cerebral ischemia]
R Juglard1, A Elfikri, H Paoletti
1Service de Radiologie, HIA Sainte Anne, boulevard Sainte-Anne, 83800 Toulon Naval, France.
Abstract:
Paradoxical embolism (PE) is an uncommonly diagnosed cause of unexplained ischemic cerebral event. Its diagnosis is based on established criteria and the failure to identify an arterial or cardiac embolic source. The association between patent foramen ovale (PFO) and cryptogenic stroke has repeatedly been demonstrated in clinical studies. Transesophageal contrast echocardiography is the best diagnostic test. Surgical or endovascular PFO closure is recommended for the long-term prevention of PE.
Insights
Paradoxical embolism, a rare cause of stroke, occurs when a clot travels from the venous to the arterial system, often linked to a patent foramen ovale (PFO). Diagnosis and PFO closure are key for preventing future paradoxical embolism events.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Paradoxical embolism (PE) is an infrequent cause of cryptogenic ischemic cerebral events.
- Diagnosis relies on excluding other embolic sources and meeting specific criteria.
- Patent foramen ovale (PFO) is frequently implicated in cryptogenic stroke.
Observation:
- Transesophageal contrast echocardiography is the preferred diagnostic modality for identifying PFO.
- The link between PFO and cryptogenic stroke is well-established in clinical research.
Findings:
- Establishing the diagnosis of PE requires ruling out arterial and cardiac sources of embolism.
- PFO is a significant contributing factor in a subset of patients experiencing unexplained ischemic strokes.
Implications:
- Early diagnosis of PE and identification of PFO are crucial for effective patient management.
- Interventional closure of PFO (surgical or endovascular) offers a strategy for long-term prevention of recurrent PE.
- Further research into the mechanisms and optimal treatment of PE associated with PFO is warranted.