Journal of Neurology

, Volume 254, Issue 6, pp 763–766

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

  • Yuji Ueno
  • Yasuyuki Iguchi
  • Takeshi Inoue
  • Kensaku Shibazaki
  • Takao Urabe
  • Kazumi Kimura



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).


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).


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).


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

Key words

paradoxical embolism right-to-left shunt patent foramen ovale transesophageal echocardiography transcranial Doppler 


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Copyright information

© Steinkopff-Verlag 2007

Authors and Affiliations

  • Yuji Ueno
    • 1
    • 2
  • Yasuyuki Iguchi
    • 1
  • Takeshi Inoue
    • 1
  • Kensaku Shibazaki
    • 1
  • Takao Urabe
    • 2
  • Kazumi Kimura
    • 1
  1. 1.Stroke center, Dept. of Stroke MedicineKawasaki Medical School, Okayama JapanOkayamaJapan
  2. 2.Dept. of NeurologyJuntendo University, School of Medicine, Tokyo JapanTokyoJapan

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