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Cerebral Ischemic Coma Model Induced by Modified Four-Vessel Occlusion
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Paradoxical cerebral embolism causing internal carotid artery occlusion
Shuhei Okazaki1, Masahiro Oomura, Kuni Konaka
1Department of Cerebrovascular Medicine, National Cardiovascular Center, Suita, Japan. s-okazaki@umin.ac.jp
Internal Medicine (Tokyo, Japan)
|May 29, 2007
Summary
Paradoxical cerebral embolism (PCE) occurs when venous emboli enter arterial circulation via a right-to-left shunt. This case report details a rare instance of PCE causing internal carotid artery occlusion.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Paradoxical cerebral embolism (PCE) involves venous emboli traversing a right-to-left (R-L) shunt to the brain.
- Typically, emboli pass through a patent foramen ovale during increased right atrial pressure, often during Valsalva maneuvers.
- PCE-induced cerebral infarcts are usually small due to the limited size of emboli that can pass through R-L shunts.
Observation:
- This report presents an unusual case of PCE.
- The observed PCE resulted in the occlusion of the internal carotid artery (ICA).
Findings:
- The case demonstrates that PCE can lead to significant arterial occlusion, contrary to the typical small infarct size.
- This finding challenges the conventional understanding of the potential severity of PCE.
Implications:
- Highlights the need for considering PCE in the differential diagnosis of arterial ischemic stroke, even with large vessel occlusion.
- Suggests that the characteristics and clinical presentation of PCE may be more diverse than previously recognized.
- Emphasizes the importance of evaluating for R-L shunts in cryptogenic strokes, particularly in younger patients or those with specific risk factors.
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