Journal of Neurology

, Volume 254, Issue 6, pp 763–766

Paradoxical brain embolism may not be uncommon-Prospective study in acute ischemic stroke

Authors

    • Stroke center, Dept. of Stroke MedicineKawasaki Medical School, Okayama Japan
    • Dept. of NeurologyJuntendo University, School of Medicine, Tokyo Japan
  • Yasuyuki Iguchi
    • Stroke center, Dept. of Stroke MedicineKawasaki Medical School, Okayama Japan
  • Takeshi Inoue
    • Stroke center, Dept. of Stroke MedicineKawasaki Medical School, Okayama Japan
  • Kensaku Shibazaki
    • Stroke center, Dept. of Stroke MedicineKawasaki Medical School, Okayama Japan
  • Takao Urabe
    • Dept. of NeurologyJuntendo University, School of Medicine, Tokyo Japan
  • Kazumi Kimura
    • Stroke center, Dept. of Stroke MedicineKawasaki Medical School, Okayama Japan
ORIGINAL COMMUNICATION

DOI: 10.1007/s00415-006-0430-6

Cite this article as:
Ueno, Y., Iguchi, Y., Inoue, T. et al. J Neurol (2007) 254: 763. doi:10.1007/s00415-006-0430-6

Abstract

Background

Proving that right-to-left shunt (RLS) represents the precise causative mechanism in ischemic stroke patients with RLS is difficult. The aim of this study was to examine the frequency and clarify the clinical characteristics of paradoxical brain embolism (PBE).

Methods

We prospectively enrolled consecutive acute ischemic stroke patients, who underwent transcranial Doppler and/or transesophageal echocardiography. For patients with RLS, diagnostic criteria for PBE were established as follows: 1) brain images suggesting embolic strokes; 2) presence of deep venous thrombus or pulmonary embolism; and 3) absence of any embolic sources. Patients were divided into 4 groups: patients meeting all 3 criteria (Definite); fulfilling 2 criteria (Probable); fulfilling 1 or 0 criteria (Possible); and patients without RLS (Non-RLS).

Results

A total of 240 subjects were analyzed for this study. The Definite group comprised 5% of patients, and displayed significantly more females (p = 0.038), and infarcts involving both anterior and posterior circulations (p < 0.001). Patients having neither hypertension nor diabetes mellitus also predominantly belonged to the Definite group (p < 0.001).

Conclusions

Clinical characteristics of PBE are a female preponderance, infarcts affecting both anterior and posterior circulations, and an absence of risk factors.

Key words

paradoxical embolismright-to-left shuntpatent foramen ovaletransesophageal echocardiographytranscranial Doppler

Copyright information

© Steinkopff-Verlag 2007