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Evidence of Paradoxical Embolism

Arch Neurol. 2004;61:1133.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Strokes of undetermined etiology, or cryptogenic strokes, account for as many as 40% of cerebral infarcts.¹ Lechat et al² have shown that the presence of a patent foramen ovale (PFO) is associated with cryptogenic stroke. The PFO is a remnant of fetal circulation. In utero, it functions as a conduit for oxygenated blood from the right to the left atrium, bypassing the lungs. At birth, the path of circulation changes, and the foramen ovale is sealed in the first year of life. However, in a significant percentage of the population, a persistent connection is seen. The presumed mechanism of cerebral ischemia is right-to-left shunting through the PFO. This abnormal communication between the left and right atria allows emboli from the venous system to pass through and cause arterial embolization. Most reports of PFO-associated strokes do not demonstrate a venous source of embolism in combination with an intracardiac thrombus. We describe . . . [Full Text of this Article]

Teresa Farrugia, MD; Richard B. Libman, MD, FRCPC