Cerebral emboli of paradoxical origin

Area of Science:

• Neurology
• Cardiology
• Vascular Medicine

Background:

• Paradoxical cerebral embolus (PCE) is a rare cause of ischemic stroke.
• PCE involves the passage of a clot from the venous to the arterial circulation, bypassing the lungs.
• Common causes include intracardiac shunts like patent foramen ovale or atrial septal defects.

Observation:

• This study reports on five patients aged 31-62 years experiencing eight cerebral ischemic events.
• None of the patients had typical sources of embolism, such as carotid artery disease or left heart abnormalities.
• A probe-patent foramen ovale was identified in four patients; the fifth had an undiagnosed atrial septal defect.

Findings:

• The presumed mechanism for cerebral ischemia in four patients was a probe-patent foramen ovale.
• An unsuspected congenital atrial septal defect was the cause in the fifth patient.
• Clinically evident venous thrombosis or pulmonary embolism was present in only one patient.

Implications:

• PCE should be considered in patients with cerebral emboli and no clear left-sided cardiac or carotid source.
• Identifying underlying intracardiac defects is crucial for diagnosis and management.
• Prompt recognition and treatment can significantly improve patient outcomes and survival rates in cases of PCE.