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Paradoxical cerebral embolism: eight cases.

J Biller, H P Adams, M R Johnson

    Neurology
    |October 1, 1986
    PubMed
    Summary
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    Paradoxical cerebral embolism, a cause of stroke, can occur without obvious risk factors. Contrast echocardiography is a key diagnostic tool for identifying right-to-left shunting in these cases.

    Area of Science:

    • Neurology
    • Cardiology
    • Vascular Medicine

    Background:

    • Paradoxical cerebral embolism is a rare but serious cause of stroke.
    • Identifying predisposing conditions and diagnostic methods is crucial for patient management.

    Purpose of the Study:

    • To evaluate patients with suspected paradoxical cerebral embolism.
    • To identify common clinical presentations and underlying causes.
    • To assess the utility of contrast echocardiography in diagnosis.

    Main Methods:

    • Retrospective analysis of eight patients with possible or probable paradoxical cerebral embolism.
    • Review of clinical history, diagnostic tests including contrast echocardiography and cardiac catheterization.

    Main Results:

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    • One patient experienced a transient ischemic attack; seven had cerebral infarcts.
    • Potential triggers included Valsalva's maneuver, catheterization, venous thrombosis, atrial myxoma, and oral contraceptives.
    • Six patients showed right-to-left shunting on contrast echocardiography.
    • Cardiac catheterization revealed patent foramen ovale in three and atrial septal defect in one patient.

    Conclusions:

    • Paradoxical cerebral embolism should be considered in young patients with unexplained cerebral events.
    • Contrast echocardiography is a valuable screening tool for detecting right-to-left shunting, aiding diagnosis.