This Article Full Text Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rahman, A. Articles by Rajendran, S. Search for Related Content PubMed PubMed Citation Articles by Rahman, A. Articles by Rajendran, S. Related Collections Cerebrovascular disease/stroke Other Treatment Embolic stroke Imaging Arterial thrombosis Deep vein thrombosis

Cardiovascular Images

Paradoxical Embolism via a Patent Foramen Ovale

An Important Mechanism of Cryptogenic Strokes

Atifur Rahman, FRACP; Rohan Jayasinghe, FRACP, PhD and Sharmalar Rajendran, FRACP

From the Cardiology Unit (A.R., R.J., S.R.), Gold Coast Hospital, Discipline of Medicine, Griffith University, and the Discipline of Medicine, (R.J.), Bond University, Queensland, Australia.

Correspondence to Dr Sharmalar Rajendran, Cardiology Unit, Gold Coast Hospital, 108 Nerang St, Southport, Queensland 4215, Australia. E-mail sharmalar@hotmail.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 56-year-old woman presented with acute confusion. Medical history was unremarkable, and she was not on any regular medication. On examination, she was hemodynamically stable and in sinus rhythm. She had global dysphasia, right-sided upper motor neuron facial paralysis, and hemiplegia as well as right hemineglect. Cardiovascular examination was unremarkable, and no carotid bruits were audible. The MRI of the brain revealed a large left middle cerebral artery territory infarct considerable mass effect (Figure 1a), and the magnetic resonance angiography revealed a thrombus within the mainstem of the left middle cerebral artery. A transeosphageal echocardiogram revealed a massive intracardiac thrombus extending through a patent foramen ovale (PFO) into the left atrium (Figure 2a). Atrial septal aneurysm was not evident. Carotid ultrasound of her neck was unremarkable. Multiple filling defects consistent with pulmonary emboli were seen in the right main pulmonary artery on a computed tomography pulmonary angiogram (Figure 1b). No intra-abdominal/pelvic mass was seen on computed tomography of the abdomen and pelvis. Hypercoagulable and autoimmune states were excluded. She was anticoagulated with intravenous heparin. Repeat transeosphageal echocardiogram carried out 2 weeks later showed the patent PFO (mean diameter of PFO is 4.9 mm) with no residual thrombus (Figure 2b). A functional shunt was demonstrated by early passage of injected, aerated, saline microbubbles from the right-to-left atrial chambers. The PFO was subsequently closed percutaneously with a Premiere device (Figure 2c).

View larger version (31K):   Figure 1. a, MRI of the brain showed a left middle . . . [Full Text of this Article]