Paradoxical Embolism via a Patent Foramen Ovale

Abstract

A 56-year-old woman presented with acute confusion. Medical history was unremarkable, and she was not on any regular medication. On examination, she was hemodynamically stable and in sinus rhythm. She had global dysphasia, right-sided upper motor neuron facial paralysis, and hemiplegia as well as right hemineglect. Cardiovascular examination was unremarkable, and no carotid bruits were audible. The MRI of the brain revealed a large left middle cerebral artery territory infarct considerable mass effect (Figure 1a), and the magnetic resonance angiography revealed a thrombus within the mainstem of the left middle cerebral artery. A transeosphageal echocardiogram revealed a massive intracardiac thrombus extending through a patent foramen ovale (PFO) into the left atrium (Figure 2a). Atrial septal aneurysm was not evident. Carotid ultrasound of her neck was unremarkable. …