Bihemispheric Paradoxical Cerebral Embolism in a Patient with Pulmonary Thromboembolism and Presumptive Fistula Right-to-Left Shunt

Silméia Garcia Zanati Bazan; Gabriel Pereira Braga; Gustavo José Luvizutto; André Petean Trindade; Octávio Marques Pontes-Neto; Rodrigo Bazan

doi:10.1016/j.jstrokecerebrovasdis.2016.03.038

Bihemispheric Paradoxical Cerebral Embolism in a Patient with Pulmonary Thromboembolism and Presumptive Fistula Right-to-Left Shunt

J Stroke Cerebrovasc Dis. 2016 Jun;25(6):e95-7. doi: 10.1016/j.jstrokecerebrovasdis.2016.03.038. Epub 2016 Apr 19.

Authors

Silméia Garcia Zanati Bazan¹, Gabriel Pereira Braga², Gustavo José Luvizutto³, André Petean Trindade⁴, Octávio Marques Pontes-Neto⁵, Rodrigo Bazan²

Affiliations

¹ Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil.
² Department of Neurology, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil.
³ Department of Neurology, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil. Electronic address: [email protected].
⁴ Department of Tropical Diseases and Diagnostic Imaging, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil.
⁵ Department of Neuroscience and Behavior, Ribeirão Preto Medical School-USP, São Paulo State University, São Paulo, Brazil.

PMID: 27105566
DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.038

Abstract

We report a case of a bihemispheric paradoxical cerebral embolism in a patient with pulmonary thromboembolism and presumptive pulmonary arteriovenous fistula. The echocardiogram showed no intracardiac shunt, and the transcranial Doppler (TCD) revealed spontaneous microembolic signals in the middle cerebral arteries (MCAs), and late passage of a higher number of microembolic signals in the MCAs, compatible with right-to-left shunt (RLS). The TCD and the echocardiogram were useful for identifying the RLS when rapid neurological deterioration occurred.

Keywords: Stroke; echocardiogram; paradoxical embolism; transcranial Doppler.

Publication types

Case Reports

MeSH terms

Aged
Arteriovenous Fistula / complications*
Arteriovenous Fistula / diagnostic imaging
Cerebral Angiography / methods
Computed Tomography Angiography
Disease Progression
Echocardiography
Embolism, Paradoxical / diagnostic imaging
Embolism, Paradoxical / etiology*
Fatal Outcome
Humans
Infarction, Middle Cerebral Artery / diagnostic imaging
Infarction, Middle Cerebral Artery / etiology*
Intracranial Embolism / diagnostic imaging
Intracranial Embolism / etiology*
Male
Middle Cerebral Artery* / diagnostic imaging
Pulmonary Artery / abnormalities*
Pulmonary Artery / diagnostic imaging
Pulmonary Embolism / diagnostic imaging
Pulmonary Embolism / etiology*
Pulmonary Veins / abnormalities*
Pulmonary Veins / diagnostic imaging
Time Factors
Ultrasonography, Doppler, Transcranial

Supplementary concepts

Pulmonary Arteriovenous Fistulas