Massive cerebral infarction caused by paradoxical embolism: detection by transesophageal echocardiography.

Two days after coronary artery bypass, a 75-year-old woman had sudden dense left-sided hemiplegia. A transthoracic echocardiogram showed a suspicious mass in the right atrium and right ventricle, which was confirmed by transesophageal echocardiography. Transesophageal echocardiography further demonstrated an elongated mass across a patent foramen ovale. Deep femoral venous thrombosis and massive cerebral infarction were also noted by Doppler ultrasonography and head computed tomographic scanning, respectively. Paradoxical embolization was thought to be the cause of the stroke.