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Patent foramen ovale(PFO)is increasingly recognized in association with cryptogenic stroke.Using transesophageal echocardiography(TEE)and transcranial Doppler sonography with ultrasonic contrast medium(contract- TCD),we evaluated the frequency of a PFO as the fundamental condition of paradoxical embolism in 111 patients after cerebral ischemia.There was a right-left shunt in 50 patients(45%)with TEE.In 31 of 40 patients with stroke of unknown etiology,a PFO was the only detectable finding associated with cerebral ischemia.Using TEE as the"gold standard",the sensitivity of contrast-TCD was 91.3%,specificity 93.8%,and the overall accuracy 92.8%.Contrast-TCD failed to detect a right-left shunt in four patients but there were four other patients with negative TEE and positive contrast-TCD.We conclude that contrast-TCD is a highly sensitive method for detecting a right-left shunt.Its advantages are low cost,its ability to detect single contrast-medium embolism,and control of the Valsalva maneuver by observing the decrease of cerebral blood flow.Evidence of PFO in cryptogenic stroke should prompt a search for a subclinical venous thrombosis as the embolic source. |
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cerebrovascular accident
cerebrovascular accident,cryptogenic
cerebrovascular accident,work up for
doppler
doppler,transcranial
echocardiogram
echocardiogram,transesophageal
patent foramen ovale
thrombophlebitis
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