Neurological Sciences

, Volume 31, Issue 3, pp 341–343

Paradoxical brain embolism caused by an arterial−venous fistula: a diagnostic pitfall

  • Piergiorgio Lochner
  • Frediano Tezzon
  • Rafaelle Nardone
  • Christian Tanislav
Case Report
  • 89 Downloads

Abstract

The transesophageal echocardiography (TEE) and contrast-enhanced transcranial Doppler/Duplex ultrasonography (ceTCD) are complementary methods for diagnosing a right to left shunt across a patent foramen ovale. We report on a case of paradoxical embolism across a subclavian arterial–venous fistula. This case underlines the necessity of performing the ceTCD, as in this condition the right to left shunt could be detected by means of ceTCD, whereas the TEE reveals regular findings.

Keywords

Patent foramen ovale Arterial–venous fistula Paradoxical embolism Transesophageal echocardiography Contrast-enhanced transcranial Doppler/Duplex ultrasonography 

References

  1. 1.
    Anzola GP (2002) Clinical impact of patent foramen ovale diagnosis with transcranial Doppler. Eur J Ultrasound 16:11–20CrossRefPubMedGoogle Scholar
  2. 2.
    Blersch WK, Draganski BM, Holmer SR, Koch HJ, Schlachetzki F, Bogdahn U, Holscher T (2002) Transcranial duplex sonography in the detection of patent foramen ovale. Radiology 225:693–699CrossRefPubMedGoogle Scholar
  3. 3.
    Droste DW, Schmidt-Rimpler C, Wichter T, Dittrich R, Ritter M, Stypmann J, Ringelstein EB (2004) Right-to-left-shunts detected by transesophageal echocardiography and transcranial Doppler sonography. Cerebrovasc Dis 17:191–196CrossRefPubMedGoogle Scholar
  4. 4.
    Stone DA, Godard J, Corretti MC, Kittner SJ, Sample C, Price TR, Plotnick GD (1996) Patent foramen ovale: association between the degree of shunt by contrast transesophageal echocardiography and the risk of future ischemic neurologic events. Am Heart J 131:158–161CrossRefPubMedGoogle Scholar
  5. 5.
    Ziai WC, Oh S, Razumovsky AY, Wityk RJ (2005) Quantitation of contrast TCD in patients with and without atrial septal aneurysm. J Neuroimaging 15:250–253PubMedGoogle Scholar
  6. 6.
    Di Tullio M, Sacco RL, Gopal A, Mohr JP, Homma S (1992) Patent foramen ovale as a risk factor for cryptogenic stroke. Ann Intern Med 117:461–465PubMedGoogle Scholar
  7. 7.
    Ward R, Jones D, Haponik EF (1995) Paradoxical embolism. An under-recognized problem. Chest 108:549–558CrossRefPubMedGoogle Scholar
  8. 8.
    Webster MW, Chancellor AM, Smith HJ, Swift DL, Sharpe DN, Bass NM, Glasgow GL (1988) Patent foramen ovale in young stroke patients. Lancet 2:11–12CrossRefPubMedGoogle Scholar
  9. 9.
    Lechat P, Mas JL, Lascault G, Loron P, Theard M, Klimczac M, Drobinski G, Thomas D, Grosgogeat Y (1988) Prevalence of patent foramen ovale in patients with stroke. N Engl J Med 318:1148–1152PubMedCrossRefGoogle Scholar
  10. 10.
    Overell JR, Bone I, Lees KR (2000) Interatrial septal abnormalities and stroke: a meta-analysis of case–control studies. Neurology 55:1172–1179PubMedGoogle Scholar
  11. 11.
    Lamy C, Giannesini C, Zuber M, Arquizan C, Meder JF, Trystram D, Coste J, Mas JL (2002) Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA Study. Atrial septal aneurysm. Stroke 33:706–711CrossRefPubMedGoogle Scholar
  12. 12.
    Lucas C, Goullard L, Marchau M Jr, Godefroy O, Rondepierre P, Chamas E, Mounier-Vehier F, Leys D (1994) Higher prevalence of atrial septal aneurysms in patients with ischemic stroke of unknown cause. Acta Neurol Scand 89:210–213CrossRefPubMedGoogle Scholar
  13. 13.
    Mas JL, Arquizan C, Lamy C, Zuber M, Cabanes L, Derumeaux G, Coste J (2001) Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med 345:1740–1746CrossRefPubMedGoogle Scholar
  14. 14.
    Halldorsson A, Hunter GC, McIntyre KE, Bernhard VM (1991) Internal mammary artery subclavian vein fistula following internal jugular vein catheterization. A case report and review of the literature. J Cardiovasc Surg (Torino) 32:376–379Google Scholar
  15. 15.
    Tekkok IH, Akkurt C, Suzer T, Ozcan OE (1992) Congenital external carotid–jugular fistula: report of two cases and a review of the literature. Neurosurgery 30:272–276CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Piergiorgio Lochner
    • 1
  • Frediano Tezzon
    • 2
  • Rafaelle Nardone
    • 2
  • Christian Tanislav
    • 1
  1. 1.Department of NeurologyUniversity Hospital GiessenGiessenGermany
  2. 2.Department of NeurologyFranz Tappeiner HospitalMeranItaly

Personalised recommendations