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Hoffmann, R. A wiki for the life sciences where authorship matters. Nature Genetics (2008)

Paradoxical cerebral embolism: eight cases.

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.[1]


  1. Paradoxical cerebral embolism: eight cases. Biller, J., Adams, H.P., Johnson, M.R., Kerber, R.E., Toffol, G.J. Neurology (1986) [Pubmed]
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