McKinney W B, O'Hara W, Sreeram K, Hudson J A, Solis M
Department of Surgery, Mercer University School of Medicine, and The Medical Center of Central Georgia, Macon, USA.
J Vasc Surg. 2001 Apr;33(4):880-2. doi: 10.1067/mva.2001.111742.
Paradoxical embolism is a rare cause of ischemic stroke. We report the case of a 67-year-old man who had a saddle embolus to the carotid bifurcation successfully treated with emergency embolectomy. Transesophageal echocardiogram revealed a large patent foramen ovale and an easily demonstrable right-to-left shunt. Subsequent investigations revealed proximal deep venous thrombosis in the left femoral and popliteal veins and multiple pulmonary emboli. Long-term anticoagulation was instituted for the diagnosis of paradoxical embolism. The patient's recovery was uneventful, and he remained neurologically intact. A literature review emphasizes the role of transesophageal echocardiography and suggests that paradoxical embolism may be a more common cause of stroke than previously thought.
反常栓塞是缺血性卒中的一种罕见病因。我们报告一例67岁男性病例，其颈动脉分叉处有鞍形栓子，通过急诊取栓术成功治疗。经食管超声心动图显示有一个大的卵圆孔未闭以及易于证实的右向左分流。后续检查发现左股静脉和腘静脉近端深静脉血栓形成以及多发性肺栓塞。因诊断为反常栓塞而开始长期抗凝治疗。患者恢复顺利，神经功能保持完好。文献综述强调了经食管超声心动图的作用，并表明反常栓塞可能是比先前认为的更常见的卒中病因。
