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  • Title: Paradoxical brain embolism in a young man: is it only a patent foramen ovale?
    Author: Wozniak L, Mielczarek M, Sabiniewicz R.
    Journal: Neurol Neurochir Pol; 2015; 49(1):61-4. PubMed ID: 25666776.
    Abstract:
    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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