This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Oscar Del Brutto, MD
Instituto Nacional de Neurologia y Neurocirugia Insurgentes Sur 3877 CP 14410 México 22 DF, Mexico

Joffre Lara, MD; Alexandra De Lara, MD
Instituto Nacional de Cardiologia Mexico City

Arch Neurol. 1987;44(9):896.

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

To the Editor.

—In a review of 144 young adults with nonhemorrhagic cerebral infarcts, Adams and co-workers¹ suggested a direct relationship between right-to-left shunts demonstrated on contrast echocardiography and paradoxical brain embolism in six patients without any other evidence of cardiac or systemic disease. According to the authors' opinion, Valsalva's maneuver could be the predisposing factor for such events. We think this is a very questionable statement.

Paradoxical brain embolism usually occurs in the setting of acute cor pulmonale caused by massive pulmonary embolism or in patients with cyanotic congenital heart disease.² Such conditions were not present in the patients described by Adams et al.¹ It is also possible that right-to-left shunts occur in healthy individuals through a patent foramen ovale with Valsalva's maneuver,³ but this phenomenon should not be expected to cause paradoxical brain embolism in the absence of another concomitant factor that favors deep venous thrombosis. . . . [Full Text PDF of this Article]

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?