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Updated: Jul 16, 2026

A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Paradoxical brain embolism may not be uncommon-prospective study in acute ischemic stroke
Yuji Ueno1, Yasuyuki Iguchi, Takeshi Inoue
1Stroke center, Dept. of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki-city, Okayama, 701-0192, Japan. yuji-u@med.juntendo.ac.jp
Background:
Proving that right-to-left shunt (RLS) represents the precise causative mechanism in ischemic stroke patients with RLS is difficult. The aim of this study was to examine the frequency and clarify the clinical characteristics of paradoxical brain embolism (PBE).
Methods:
We prospectively enrolled consecutive acute ischemic stroke patients, who underwent transcranial Doppler and/or transesophageal echocardiography. For patients with RLS, diagnostic criteria for PBE were established as follows: 1) brain images suggesting embolic strokes; 2) presence of deep venous thrombus or pulmonary embolism; and 3) absence of any embolic sources. Patients were divided into 4 groups: patients meeting all 3 criteria (Definite); fulfilling 2 criteria (Probable); fulfilling 1 or 0 criteria (Possible); and patients without RLS (Non-RLS).
Results:
A total of 240 subjects were analyzed for this study. The Definite group comprised 5% of patients, and displayed significantly more females (p = 0.038), and infarcts involving both anterior and posterior circulations (p < 0.001). Patients having neither hypertension nor diabetes mellitus also predominantly belonged to the Definite group (p < 0.001).
Conclusions:
Clinical characteristics of PBE are a female preponderance, infarcts affecting both anterior and posterior circulations, and an absence of risk factors.
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