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Paradoxical cerebral embolism

Eight cases

Departments of Neurology (Division of Cerebrovascular Diseases) (Drs. Biller, Adams, and Toffol) and Medicine (Division of Cardiology) (Drs. Johnson and Kerber), University of Iowa College of Medicine, Iowa City, IA.

We evaluated eight patients with possible or probable paradoxical cerebral embolism. One patient had a hemispheric transient ischemic attack; the others had infarcts. Ischemic symptoms followed a Valsalva's maneuver in three cases. Others were linked to placement of a Swan-Ganz catheter, deep venous thrombosis and pulmonary embolism, right atrial myxoma, and use of oral contraceptives. Four had no known predisposing conditions. In six patients, contrast echocardiography showed right-to-left shunting. Cardiac catheterization showed a patent foramen ovale in three patients; one had an atrial septal defect. In the clinical setting of otherwise unexplained cerebral embolism in a young patient, paradoxical cerebral embolism should be considered. Contrast echocardiography is a useful screening test for this purpose.

Address correspondence and reprint requests to Dr. Biller, Department of Neurology, Division of Cerebrovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, IA 52242.

Accepted for publication February 16, 1986.

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