[Paradoxical embolism after femoral fracture]

The foramen ovale is anatomically open in 25% of individuals, but functionally closed by the higher pressure in the left antrum. Right-to-left shunt and subsequent paradoxical embolism may occur when pressure in the left antrum rises, for example, as a result of pulmonary embolism. In the present case we demonstrate a patient who presented 20 days after osteosynthetic treatment of a femoral fracture with word-finding deficits. Cerebral MRT revealed a fresh ischemic insult. Duplex ultrasound of the legs showed a fresh thrombosis of the superficial femoral vein and scintigraphy of the lungs detected pulmonary embolism. Transesophageal contrast echocardiography trapped a hemodynamically spontaneous, open foramen ovale. Duplex ultrasound of the carotid arteries detected no pathological findings. Deep vein thrombosis and pulmonary embolism can be clinically inconspicuous and become manifest by cerebral deficits resulting from paradox embolism and cerebral ischemia.