Cerebral emboli of paradoxical origin
Article first published online: 16 OCT 2004
Copyright © 1983 American Neurological Association
Annals of Neurology
Volume 13, Issue 3, pages 314–319, March 1983
How to Cite
Jones, H. R., Caplan, L. R., Come, P. C., Swinton, N. W. and Breslin, D. J. (1983), Cerebral emboli of paradoxical origin. Ann Neurol., 13: 314–319. doi: 10.1002/ana.410130315
- Issue published online: 16 OCT 2004
- Article first published online: 16 OCT 2004
- Manuscript Accepted: 25 JUL 1982
- Manuscript Revised: 22 JUL 1982
- Manuscript Received: 24 MAY 1982
A diagnosis of paradoxical cerebral embolus (PCE) was made in five patients aged 31 to 62 years who sustained eight cerebral ischemic events. No patient had evidence of primary carotid system or left heart disease. A probe-patent foramen ovale was the presumed mechanism in four patients, and an unsuspected congenital atrial septal defect was found in the fifth patient. Clinically apparent pulmonary emboli or venous thrombosis preceded the cerebral event in only one instance.
Review of the literature reveals a high mortality with PCE. However, careful clinical search for this lesion may be rewarding: four of our five patients survived. One should consider PCE in any patient with cerebral embolus in whom there is no demonstrable left-sided circulatory source. This principle applies particularly if there is concomitant venous thrombosis, pulmonary embolism, or enhanced potential for venous thrombosis due to, for example, morbid obesity, use of hormonal birth control pills, prolonged bed rest (especially postoperatively), or systemic carcinoma.