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Cerebral emboli of paradoxical origin
Abstract:
A diagnosis of paradoxical cerebral embolus (PCE) was made in five patients aged 31 to 62 years who sustained eight cerebral ischemic events. No patient had evidence of primary carotid system or left heart disease. A probe-patent foramen ovale was the presumed mechanism in four patients, and an unsuspected congenital atrial septal defect was found in the fifth patient. Clinically apparent pulmonary emboli or venous thrombosis preceded the cerebral event in only one instance. Review of the literature reveals a high mortality with PCE. However, careful clinical search for this lesion may be rewarding: four of our five patients survived. One should consider PCE in any patient with cerebral embolus in whom there is no demonstrable left-sided circulatory source. This principle applies particularly if there is concomitant venous thrombosis, pulmonary embolism, or enhanced potential for venous thrombosis due to, for example, morbid obesity, use of hormonal birth control pills, prolonged bed rest (especially postoperatively), or systemic carcinoma.
Insights
Paradoxical cerebral embolus (PCE) occurs when a clot travels from the venous system to the brain. Early diagnosis and intervention improve survival rates for this rare condition.
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.