Abstract

A young woman had sudden onset of a left hemiparesis. Initial studies showed a right internal carotid artery (ICA) thrombus and reduced flow in the right middle cerebral artery (MCA). The next day, the right ICA and MCA were widely patent but thrombi were present in MCA branches. Echocardiography and transcranial Doppler studies later showed a patent foramen ovale, with passage of air bubbles through the atrial septum into the MCA. Thromboembolism is a dynamic process. Segmental ultrasound studies can document and follow the passage of emboli.

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