Biller J, Adams H P, Johnson M R, Kerber R E, Toffol G J
Neurology. 1986 Oct;36(10):1356-60. doi: 10.1212/wnl.36.10.1356.
We evaluated eight patients with possible or probable paradoxical cerebral embolism. One patient had a hemispheric transient ischemic attack; the others had infarcts. Ischemic symptoms followed a Valsalva's maneuver in three cases. Others were linked to placement of a Swan-Ganz catheter, deep venous thrombosis and pulmonary embolism, right atrial myxoma, and use of oral contraceptives. Four had no known predisposing conditions. In six patients, contrast echocardiography showed right-to-left shunting. Cardiac catheterization showed a patent foramen ovale in three patients; one had an atrial septal defect. In the clinical setting of otherwise unexplained cerebral embolism in a young patient, paradoxical cerebral embolism should be considered. Contrast echocardiography is a useful screening test for this purpose.
我们评估了8例可能或很可能患有反常脑栓塞的患者。1例患者发生了半球性短暂性脑缺血发作；其他患者发生了梗死。3例患者在做瓦尔萨尔瓦动作后出现缺血症状。其他患者与放置 Swan-Ganz 导管、深静脉血栓形成和肺栓塞、右心房黏液瘤以及使用口服避孕药有关。4例患者无已知的易感因素。6例患者经对比超声心动图检查显示有右向左分流。心导管检查显示3例患者存在卵圆孔未闭；1例患者有房间隔缺损。在年轻患者出现无法解释的脑栓塞的临床情况下，应考虑反常脑栓塞。对比超声心动图是用于此目的的一种有用的筛查试验。
