Cerebral emboli of paradoxical origin

Authors

  • Dr H. Royden Jones Jr MD,

    Corresponding author
    1. Department of Neurology, Lahey Clinic Medical Center, Burlington, MA 01805
    2. Harvard Medical School, Boston, MA 02115
    • Department of Neurology, Lahey Clinic Medical Center, 41 Mall Rd, Box 541, Burlington, MA 01805
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  • Louis R. Caplan MD,

    1. Harvard Medical School, Boston, MA 02115
    2. Department of Neurology, Beth Israel Hospital, Boston, MA 02215
    Current affiliation:
    1. Department of Neurology, Michael Reese Hospital, Chicago, IL 60616
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  • Patricia C. Come MD,

    1. Harvard Medical School, Boston, MA 02115
    2. Department of Cardiology, Beth Israel Hospital, Boston, MA 02215
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  • Neil W. Swinton Jr MD,

    1. Section of Vascular Diseases, Lahey Clinic Medical Center, Burlington, MA 01805
    2. Harvard Medical School, Boston, MA 02115
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  • Donald J. Breslin MD

    1. Section of Vascular Diseases, Lahey Clinic Medical Center, Burlington, MA 01805
    2. Harvard Medical School, Boston, MA 02115
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Abstract

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.

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