Vol 49, No 1 (2015)

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Paradoxical brain embolism in a young man: Is it only a patent foramen ovale?

Lidia Wozniak1, Maksymilian Mielczarek2, Robert Sabiniewicz1
DOI: 10.1016/j.pjnns.2014.12.003
Neurol Neurochir Pol 2015;49(1):61-64.


Paradoxical embolism is considered the major cause of cerebral ischemic events in young patients. The most common cause of paradoxical embolism, which has been widely described, is right-to-left shunting (RLS) at cardiac level through a patent foramen ovale (PFO). Rarely paradoxical embolism can also be caused by RLS at pulmonary level due to pulmonary arteriovenous fistula (PAVF). Herein, we present a case of a young man, who experienced transient ischemic attack (TIA) due to paradoxical embolism, in whom both abovementioned abnormalities coexisted. This coincidence is very rare (noted in only 1% of patients with cryptogenic stroke or TIA), but it highlights the importance of searching for extracardiac RLS in patients with cryptogenic stroke, even if a PFO has been detected.

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Neurologia i Neurochirurgia Polska