Paradoxical Embolisms and Strokes

doi:10.1017/9781316551684.071

Chapter 70 - Paradoxical Embolisms and Strokes

from Section 7 - Non-Inflammatory Disorders of the Arterial Wall

Published online by Cambridge University Press: 15 June 2018

David E. Thaler and

Steven C. Cramer

Edited by

Louis Caplan and

José Biller

Show author details

Louis Caplan: Affiliation:
Beth Israel-Deaconess Medical Center, Boston
José Biller: Affiliation:
Loyola University Stritch School of Medicine, Chicago

Book contents

Get access

Summary

A summary is not available for this content so a preview has been provided. Please use the Get access link above for information on how to access this content.

Image of the first page of this content. For PDF version, please use the ‘Save PDF’ preceeding this image.'

Information

Type: Chapter
Information: Uncommon Causes of Stroke , pp. 565 - 574

DOI: https://doi.org/10.1017/9781316551684.071 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Adams, H., Bendixen, B., Kappelle, L., et al., 1993. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke, 24, 35–41.10.1161/01.STR.24.1.35CrossRef Google Scholar

Aggarwal, K., Jayam, V. K., Meyer, M. A., Nayak, A. K., and Nathan, S. 2002. Thrombus-in-transit and paradoxical embolism. J Am Soc Echocardiogr, 15, 1021–2.10.1067/mje.2002.121279CrossRef Google Scholar PubMed

Albers, G., Amarenco, P., Easton, J., Sacco, R., and Teal, P. 2001. Antithrombotic and thrombolytic therapy for ischemic stroke. Chest, 119, S300–20.CrossRef Google Scholar PubMed

Alsheikh-Ali, A., Thaler, D., and Kent, D. 2009. Patent foramen ovale in cryptogenic stroke: incidental or pathogenic? Stroke, 40, 2349–55.CrossRef Google Scholar PubMed

Au, V., Walsh, G., and Fon, G. 2001. Computed tomography pulmonary angiography with pelvic venography in the evaluation of thrombo-embolic disease. Australas Radiol, 45, 141–5.10.1046/j.1440-1673.2001.00869.xCrossRef Google Scholar PubMed

Ay, H., Buonanno, F., Abraham, S., Kistler, J., and Koroshetz, W. 1998. An electrocardiographic criterion for diagnosis of patent foramen ovale associated with ischemic stroke. Stroke, 29, 1393–7.10.1161/01.STR.29.7.1393CrossRef Google Scholar PubMed

Bendixen, B., Posner, J., and Lango, R. 2001. Stroke in young adults and children. Curr Neurol Neurosci Rep, 1, 54–66.10.1007/s11910-001-0077-8CrossRef Google Scholar PubMed

Bergqvist, D. and Bergentz, S. E. 1990. Diagnosis of deep vein thrombosis. World J Surg, 14, 679–87.10.1007/BF01658825CrossRef Google Scholar PubMed

Berthet, K., Lavergne, T., Cohen, A., et al. 2000. Significant association of atrial vulnerability with atrial septal abnormalities in young patients with ischemic stroke of unknown cause. Stroke, 31, 398–403.10.1161/01.STR.31.2.398CrossRef Google Scholar

Cabanes, L., Mas, J., Cohen, A., et al. 1993. Atrial septal aneurysm and patent foramen ovale as risk factors for CS in patients less than 55 years of age. A study using transesophageal echocardiography. Stroke, 24, 1865–73.10.1161/01.STR.24.12.1865CrossRef Google Scholar

Cakmak, S., Nighoghossian, N., Desestret, V., et al. 2005. Pulmonary embolism: An unusual complication of cerebral venous thrombosis. Neurology, 65, 1136–7.10.1212/01.wnl.0000178987.06734.54CrossRef Google Scholar PubMed

Calabro, R., La Spina, P., Serra, S., et al. 2009. Prevalence of prothrombotic polymorphisms in a selected cohort of cryptogenic and noncryptogenic ischemic stroke patients. Neurol India, 57, 636–7.CrossRef Google Scholar

Carroll, J., Saver, J., Thaler, D., et al. 2013. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. N Engl J Med, 368, 1092–1100.10.1056/NEJMoa1301440CrossRef Google Scholar PubMed

Chant, H. and McCollum, C. 2001. Stroke in young adults: The role of paradoxical embolism. Thromb Haemost, 85, 22–9.CrossRef Google Scholar PubMed

Chaturvedi, S. 1998. Coagulation abnormalities in adults with CS and patent foramen ovale. J Neurol Sci, 160, 158–60.10.1016/S0022-510X(98)00243-3CrossRef Google Scholar PubMed

Cohnheim, J. 1877. Thrombose und Embolie, Vorlesungen über Allgemeine Pathologie; ein Handbuch für Aertze und Studierende. Berlin: Hirschwald.Google Scholar

Corrin, B. 1964. Paradoxical embolism. Br Heart J, 26, 549–53.10.1136/hrt.26.4.549CrossRef Google Scholar PubMed

Cramer, S., Rordorf, G., Kaufman, J., et al. 1998. Clinically occult pelvic-vein thrombosis in CS. Lancet, 351, 1927–8.10.1016/S0140-6736(05)78611-6CrossRef Google Scholar

Cramer, S., Maki, J., Waitches, G., et al. 2003. Paradoxical emboli from calf and pelvic veins in CS. J Neuroimaging, 13, 218–23.10.1111/j.1552-6569.2003.tb00181.xCrossRef Google Scholar

Cramer, S., Rordorf, G., Maki, J., et al. 2004. Increased pelvic vein thrombi in CS: results of the Paradoxical Emboli from Large Veins in Ischemic Stroke (PELVIS) study. Stroke, 35, 46–50.10.1161/01.STR.0000106137.42649.ABCrossRef Google Scholar

Dahabreh, I. and Kent, D. 2011. Index event bias as an explanation for the paradoxes of recurrence risk research. JAMA, 305, 822–3.10.1001/jama.2011.163CrossRef Google Scholar

de Belder, M., Tourikis, L., Leech, G., and Camm, A. 1992. Risk of patent foramen ovale for thromboembolic events in all age groups. Am J Cardiol, 69, 1316–20.10.1016/0002-9149(92)91228-VCrossRef Google Scholar PubMed

De Castro, S., Cartoni, D., Fiorelli, M., et al. 2000. Morphological and functional characteristics of patent foramen ovale and their embolic implications. Stroke, 31, 2407–13.10.1161/01.STR.31.10.2407CrossRef Google Scholar PubMed

Di Tullio, M., Sacco, R., Gopal, A., Mohr, J., and Homma, S. 1992. Patent foramen ovale as a risk factor for CS. Ann Intern Med, 117, 461–5.10.7326/0003-4819-117-6-461CrossRef Google Scholar

Di Tullio, M., Jin, Z., Russo, C., et al. 2013. Patent foramen ovale, subclinical cerebrovascular disease, and ischemic stroke in a population-based cohort. J Am Coll Cardiol Img, 62, 35–41.10.1016/j.jacc.2013.03.064CrossRef Google Scholar

Dodge, S. M., Hassell, K., Anderson, C. A., et al. 2004. Antiphospholipid antibodies are common in patients referred for percutaneous patent foramen ovale closure. Catheter Cardiovasc Interv, 61, 123–7.CrossRef Google Scholar PubMed

Droste, D., Lakemeier, S., Wichter, T., et al. 2002. Optimizing the technique of contrast transcranial Doppler ultrasound in the detection of right-to-left shunts. Stroke, 33, 2211–6.10.1161/01.STR.0000027884.03365.ACCrossRef Google Scholar PubMed

Dubourg, O., Rigaud, M., and Bardet, J. 1984. Contrast echocardiographic visualization of cough-induced right-to-left shunt through a patent foramen ovale. J Am Coll Cardiol, 4, 587–94.10.1016/S0735-1097(84)80106-0CrossRef Google Scholar PubMed

Fedullo, P. F. and Tapson, V. F. 2003. Clinical practice. The evaluation of suspected pulmonary embolism. N Engl J Med, 349, 1247–56.10.1056/NEJMcp035442CrossRef Google Scholar PubMed

Foster, P. P., Boriek, A. M., Butler, B. D., Gernhardt, M. L., and Bove, A. A. 2003. Patent foramen ovale and paradoxical systemic embolism: A bibliographic review. Aviat Space Environ Med, 74, B1–64.Google Scholar PubMed

Foulkes, M., Wolf, P., Price, T., et al., 1988. The Stroke Data Bank: Design, methods, and baseline characteristics. Stroke, 19, 547–54.10.1161/01.STR.19.5.547CrossRef Google Scholar PubMed

Fraser, D., Moody, A., Morgan, P., Martel, A., and Davidson, I. 2002. Diagnosis of lower-limb deep venous thrombosis: A prospective blinded study of magnetic resonance direct thrombus imaging. Ann Intern Med, 136, 89–98.CrossRef Google Scholar PubMed

Fraser, D., Moody, A., Davidson, I., Martel, A., and Morgan, P. 2003. Deep venous thrombosis: Diagnosis by using venous enhanced subtracted peak arterial MR venography versus conventional venography. Radiology, 226, 812–20.10.1148/radiol.2263012205CrossRef Google Scholar PubMed

Furlan, A., Reisman, M., Massaro, J., et al. 2012. Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med, 366, 991–9.10.1056/NEJMoa1009639CrossRef Google Scholar PubMed

Gautier, J., Durr, A., Koussa, S., Lasault, G., and Grosgogeat, T. 1991. Paradoxical cerebral embolism with a patent foramen ovale. Cerebrovasc Dis, 1, 193–202.10.1159/000108842CrossRef Google Scholar

Georgopoulos, S., Chronopoulos, A., Dervisis, K., and Arvanitis, D. 2001. Paradoxical embolism. An old but, paradoxically, under-estimated problem. J Cardiovasc Surg (Torino), 42, 675–7.Google Scholar PubMed

Gin, K., Huckell, V., and Pollick, C. 1993. Femoral vein delivery of contrast medium enhances transthoracic echocardiographic detection of patent foramen ovale. J Am Coll Cardiol, 22, 1994–2000.10.1016/0735-1097(93)90789-4CrossRef Google Scholar PubMed

Greer, D. and Buonanno, F. 2001. Cerebral infarction in conjunction with patent foramen ovale and May–Thurner syndrome. J Neuroimaging, 11, 432–4.10.1111/j.1552-6569.2001.tb00074.xCrossRef Google Scholar PubMed

Ha, J., Shin, M., Kang, S., et al. 2001. Enhanced detection of right-to-left shunt through patent foramen ovale by transthoracic contrast echocardiography using harmonic imaging. Am J Cardiol, 87, 669–71, A11.10.1016/S0002-9149(00)01455-7CrossRef Google Scholar PubMed

Haeusler, K., Herm, J., Hoppe, B., et al. 2012. Thrombophilia screening in young patients with cryptogenic stroke. Prevalence of gene polymorphisms compared to healthy blood donors and impact on secondary stroke prevention. Hamostaseologie 32, 147–152.Google Scholar

Hagen, P., Scholz, D., and Edwards, W. 1984. Incidence and size of patent foramen ovale during the first 10 decades of life: An autopsy study of 965 normal hearts. Mayo Clin Proc, 59, 17–20.10.1016/S0025-6196(12)60336-XCrossRef Google Scholar PubMed

Hamann, G., Schatzer-Klotz, D., Frohlig, G., et al. 1998. Femoral injection of echo contrast medium may increase the sensitivity of testing for a patent foramen ovale. Neurology, 50, 1423–8.10.1212/WNL.50.5.1423CrossRef Google Scholar PubMed

Hart, R., Diener, H., Coutts, S., et al. 2014. Embolic strokes of undetermined source: The case for a new clinical construct. Lancet Neurol, 13, 429–38.Google Scholar PubMed

Hausmann, D., Mugge, A., Becht, I., and Daniel, W. 1992. Diagnosis of patent foramen ovale by transesophageal echocardiography and association with cerebral and peripheral embolic events. Am J Cardiol, 70, 668–72.10.1016/0002-9149(92)90210-PCrossRef Google Scholar

Hausmann, D., Mugge, A., and Daniel, W. 1995. Identification of patent foramen ovale permitting paradoxic embolism. J Am Coll Cardiol, 26, 1030–8.10.1016/0735-1097(95)00288-9CrossRef Google Scholar PubMed

Havig, O. 1977a. Deep vein thrombosis. Acta Chir Scand, 478, S4–11.Google Scholar PubMed

Havig, O. 1977b. Source of pulmonary emboli. Acta Chir Scand, 478, S42–7.Google Scholar

Hirsh, J. and Hoak, J. 1996. Management of deep vein thrombosis and pulmonary embolism. A statement for healthcare professionals. Council on Thrombosis (in consultation with the Council on Cardiovascular Radiology), American Heart Association. Circulation, 93, 2212–45.10.1161/01.CIR.93.12.2212CrossRef Google Scholar PubMed

Homma, S., Di Tullio, M., Sacco, R., et al. 1994. Characteristics of patent foramen ovale associated with CS. A biplane transesophageal echocardiographic study. Stroke, 25, 582–6.10.1161/01.STR.25.3.582CrossRef Google Scholar

Homma, S., Sacco, R., Di Tullio, M., et al. 2002. Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in the CS Study. Circulation, 105, 2625–31.10.1161/01.CIR.0000017498.88393.44CrossRef Google Scholar

Horowitz, P. E. 2002. Fat embolism. Anaesthesia, 57, 830–1.10.1046/j.1365-2044.2002.02752_17.xCrossRef Google Scholar PubMed

Jacobs, B., Boden-Albala, B., Lin, I., and Sacco, R. 2002. Stroke in the young in the northern Manhattan stroke study. Stroke, 33, 2789–93.10.1161/01.STR.0000038988.64376.3ACrossRef Google Scholar

Jeanrenaud, X., Bogousslavsky, J., Payot, M., Regli, F., and Kappenberger, L. 1990. Patent foramen ovale and cerebral infarct in young patients. Schweiz Med Wochenschr, 120, 823–9.Google Scholar PubMed

Job, F., Ringelstein, E., Grafen, Y., et al. 1994. Comparison of transcranial contrast Doppler sonography and transesophageal contrast echocardiography for the detection of patent foramen ovale in young stroke patients. Am J Cardiol, 74, 381–4.10.1016/0002-9149(94)90407-3CrossRef Google Scholar PubMed

Johnson, B. 1951. Paradoxical emboli. J Clin Pathol, 4, 316–32.10.1136/jcp.4.3.316CrossRef Google Scholar

Jones, E., Calafiore, P., Donnan, G., and Tonkin, A. 1994. Evidence that patent foramen ovale is not a risk factor for cerebral ischemia in the elderly. Am J Cardiol, 74, 596–9.CrossRef Google Scholar

Kearon, C. and Hirsh, J. 1994. Factors influencing the reported sensitivity and specificity of impedance plethysmography for proximal deep vein thrombosis. Thrombosis Haemost, 72, 652–8.Google Scholar PubMed

Kearon, C., Akl, E., Comerota, A., et al. 2012. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th edn: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 141(2 Suppl): e419S-494S.10.1378/chest.11-2301CrossRef Google Scholar

Kelly, J., Rudd, A., Lewis, R., and Hunt, B. 2001. Venous thromboembolism after acute stroke. Stroke, 32, 262–7.10.1161/01.STR.32.1.262CrossRef Google Scholar PubMed

Kent, D., Ruthazer, R., Weimer, C., et al. 2013. An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. Neurology, 81, 619–25.10.1212/WNL.0b013e3182a08d59CrossRef Google Scholar PubMed

Kent, D., Dahabreh, I., Ruthazer, R., et al. 2015. Anticoagulant vs. antiplatelet therapy in patients with cryptogenic stroke and patent foramen ovale: An individual participant data meta-analysis. Eur Heart J, 36, 2381–9.10.1093/eurheartj/ehv252CrossRef Google Scholar PubMed

Kent, D. M., Dahabreh, I. J., Ruthazer, R., et al. 2016. Device closure of patent foramen ovale after stroke: Pooled analysis of completed randomized trials. J Am Coll Cardiol, 67, 907–17.10.1016/j.jacc.2015.12.023CrossRef Google Scholar PubMed

Kerut, E., Norfleet, W., Plotnick, G., and Giles, T. 2001. Patent foramen ovale: A review of associated conditions and the impact of physiological size. J Am Coll Cardiol, 38, 613–23.10.1016/S0735-1097(01)01427-9CrossRef Google Scholar PubMed

Kiernan, T., Yan, B., Cubeddu, R., et al. 2009. May–Thurner syndrome in patients with cryptogenic stroke and patent foramen ovale: An important clinical association. Stroke, 40, 1502–4.10.1161/STROKEAHA.108.527366CrossRef Google Scholar PubMed

Kitsios, G., Dahabreh, I., Abu, D., et al. 2012. Patent foramen ovale closure and medical treatments for secondary stroke prevention: A systematic review of observational and randomized evidence. Stroke, 43, 422–31.10.1161/STROKEAHA.111.631648CrossRef Google Scholar PubMed

Kitsios, G. D., Thaler, D. E., and Kent, D. M. 2013. Potentially large yet uncertain benefits: A meta-analysis of patent foramen ovale closure trials. Stroke, 44, 2640–3.10.1161/STROKEAHA.113.001773CrossRef Google Scholar PubMed

Klotzsch, C., Janssen, G., and Berlit, P. 1994. Transesophageal echocardiography and contrast-TCD in the detection of a patent foramen ovale. Neurology, 44, 1603–6.CrossRef Google Scholar PubMed

Koessler, M. J. and Pitto, R. P. 2002. Fat embolism and cerebral function in total hip arthroplasty. Int Orthop, 26, 259–62.Google Scholar PubMed

Konstantinides, S., Geibel, A., Kasper, W., et al. 1998. Patent foramen ovale is an important predictor of adverse outcome in patients with major pulmonary embolism. Circulation, 97, 1946–51.10.1161/01.CIR.97.19.1946CrossRef Google Scholar

Kunitz, S., Gross, C., Heyman, A., et al., 1984. The pilot Stroke Data Bank: Definition, design, and data. Stroke, 15, 740.10.1161/01.STR.15.4.740CrossRef Google Scholar

Lamy, C., Giannesini, C., Zuber, M., et al. 2002. Clinical and imaging findings in CS patients with and without patent foramen ovale: The PFO–ASA Study. Atrial septal aneurysm. Stroke, 33, 706–11.10.1161/hs0302.104543CrossRef Google Scholar

Landi, G., D’Angelo, A., Boccardi, E., et al. 1992. Venous thromboembolism in acute stroke: Prognostic importance of hypercoagulability. Arch Neurol, 49, 279–83.10.1001/archneur.1992.00530270093024CrossRef Google Scholar PubMed

Lapergue, B., Decroix, J., Evrard, S., et al. 2015. Diagnostic yield of venous thrombosis and pulmonary embolism by combined CT venography and pulmonary angiography in patients with cryptogenic stroke and patent foramen ovale. Eur Neurol, 74, 69–72.10.1159/000437261CrossRef Google Scholar PubMed

Lechat, P., Mas, J., and Lascault, G. 1988. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med, 318, 1148–52.10.1056/NEJM198805053181802CrossRef Google Scholar PubMed

Leon, L., Giannoukas, A. D., Dodd, D., Chan, P., and Labropoulos, N. 2005. Clinical significance of superficial vein thrombosis. Eur J Vasc Endovasc Surg, 29, 10–7.10.1016/j.ejvs.2004.09.021CrossRef Google Scholar PubMed

Lethen, H., Flachskampf, F., Schneider, R., et al. 1997. Frequency of deep vein thrombosis in patients with patent foramen ovale and ischemic stroke or transient ischemic attack. Am J Cardiol, 80, 1066–9.10.1016/S0002-9149(97)00604-8CrossRef Google Scholar PubMed

Liberman, A., Daruwalla, V., Collins, J., et al. 2014. Diagnostic yield of pelvic magnetic resonance venography in patients with cryptogenic stroke and patent foramen ovale. Stroke, 45, 2324–9.10.1161/STROKEAHA.114.005539CrossRef Google Scholar PubMed

Lip, P. and Lip, G. 2014. Patent foramen ovale and migraine attacks: A systematic review. Am J Med, 127, 411–20.10.1016/j.amjmed.2013.12.006CrossRef Google Scholar PubMed

Lohr, J., James, K., Deshmukh, R., et al. 1995. Karmody Award. Calf vein thrombi are not a benign finding. Am J Surg, 170, 86–90.10.1016/S0002-9610(99)80261-XCrossRef Google Scholar

Loscalzo, J. 1986. Paradoxical embolism: Clinical presentation, diagnostic strategies, and therapeutic options. Am Heart J, 112, 141–5.10.1016/0002-8703(86)90692-7CrossRef Google Scholar PubMed

Loud, P., Katz, D., Bruce, D., Klippenstein, D., and Grossman, Z. 2001. Deep venous thrombosis with suspected pulmonary embolism: Detection with combined CT venography and pulmonary angiography. Radiology, 219, 498–502.10.1148/radiology.219.2.r01ma26498CrossRef Google Scholar PubMed

Maldjian, P. D., Anis, A., and Saric, M. 2006. Radiological reasoning: Pulmonary embolism – thinking beyond the clots. AJR Am J Roentgenol, 186, S219–23.10.2214/AJR.05.1622CrossRef Google Scholar PubMed

Mas, J.-L., Arquizan, C., Lamy, C., et al. 2001. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med, 345, 1740–6.10.1056/NEJMoa011503CrossRef Google Scholar PubMed

Mas, J. L, Derumeaux, G., Guillon, B., et al. 2017. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med, 377, 1011–21.10.1056/NEJMoa1705915CrossRef Google Scholar PubMed

Meier, B., Kalesan, B., Heinrich, M., et al. 2013. Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med, 368, 1083–91.10.1056/NEJMoa1211716CrossRef Google Scholar PubMed

Meissner, I., Khandheria, B. K., Heit, J. A., et al. 2006. Patent foramen ovale: Innocent or guilty? Evidence from a prospective population-based study. J Am Coll Cardiol, 47, 440–5.10.1016/j.jacc.2005.10.044CrossRef Google Scholar PubMed

Messe, S., Silverman, I., Kizer, J., et al. 2004. Practice parameter: Recurrent stroke with patent foramen ovale and atrial septal aneurysm. Neurology, 62, 1042–50.10.1212/01.WNL.0000119173.15878.F3CrossRef Google Scholar PubMed

Miller, R. L., Das, S., Anandarangam, T., et al. 1997. Relation between patent foramen ovale and perfusion abnormalities in acute pulmonary embolism. Am J Cardiol, 80, 377–8.10.1016/S0002-9149(97)00372-XCrossRef Google Scholar PubMed

Modan, B., Sharon, E., and Jelin, N. 1972. Factors contributing to the incorrect diagnosis of pulmonary embolic disease. Chest, 62, 388–93.10.1378/chest.62.4.388CrossRef Google Scholar

Mohr, J. 1988. CS. N Engl J Med, 318, 1197–8.Google Scholar

Mohr, J., Caplan, L., Melski, J., et al. 1978. The Harvard Cooperative Stroke Registry: A prospective registry of patients hospitalized with stroke. Neurology, 28, 754–62.10.1212/WNL.28.8.754CrossRef Google Scholar

Mohr, J., Thompson, J., Lazar, R., et al. 2001. A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med, 345, 1444–51.10.1056/NEJMoa011258CrossRef Google Scholar PubMed

Ning, M., Lo, E., Ning, P., et al. 2013. The brain’s heart: Therapeutic opportunities for patent foramen ovale (PFO) and neurovascular disease. Pharmacol Ther, 139, 111–123.10.1016/j.pharmthera.2013.03.007CrossRef Google Scholar PubMed

Noser, E., Felberg, R., and Alexandrov, A. 2001. Thrombolytic therapy in an adolescent ischemic stroke. J Child Neurol, 16, 286–8.CrossRef Google Scholar

Obernosterer, A., Aschauer, M., Schnedl, W., and Lipp, R. 2002. Anomalies of the inferior vena cava in patients with iliac venous thrombosis. Ann Intern Med, 136, 37–41.10.7326/0003-4819-136-1-200201010-00009CrossRef Google Scholar PubMed

Offelli, P., Zanchetta, M., Pedon, L., et al. 2007. Thrombophilia in young patients with cryptogenic stroke and patent foramen ovale (PFO). Thromb Haemost, 98, 906–7.10.1160/TH07-04-0243CrossRef Google Scholar

Osgood, M., Budman, E., Carandang, R., Goddeau, R. P. Jr., and Henninger, N. 2015. Prevalence of pelvic vein pathology in patients with cryptogenic stroke and patent foramen ovale undergoing MRV pelvis. Cerebrovasc Dis, 39, 216–223.10.1159/000376613CrossRef Google Scholar PubMed

Overell, J., Bone, I., and Lees, K. 2000. Interatrial septal abnormalities and stroke: A meta-analysis of case–control studies. Neurology, 55, 1172–9.10.1212/WNL.55.8.1172CrossRef Google Scholar PubMed

Parisi, D. M., Koval, K., and Egol, K. 2002. Fat embolism syndrome. Am J Orthop, 31, 507–12.Google Scholar PubMed

Petty, G., Khandheria, B., Chu, C.-P., Sicks, J., and Whisnant, J. 1997. Patent foramen ovale in patients with cerebral infarction. Arch Neurol, 54, 819–22.10.1001/archneur.1997.00550190013008CrossRef Google Scholar PubMed

Pezzini, A., Del Zotto, E., Magoni, M., et al. 2003. Inherited thrombophilic disorders in young adults with ischemic stroke and patent foramen ovale. Stroke, 34, 28–33.10.1161/01.STR.0000046457.54037.CCCrossRef Google Scholar

Philbrick, J. and Becker, D. 1988. Calf deep venous thrombosis. A wolf in sheep’s clothing? Arch Intern Med, 148, 2131–8.10.1001/archinte.1988.00380100029007CrossRef Google Scholar PubMed

Puls, R., Hosten, N., Bock, J., et al. 1999. Signal-enhanced color Doppler sonography of deep venous thrombosis in the lower limbs and pelvis. J Ultrasound Med, 18, 185–90.10.7863/jum.1999.18.3.185CrossRef Google Scholar PubMed

Ranoux, D., Cohen, A., Cabanes, L., et al. 1993. Patent foramen ovale: Is stroke due to paradoxical embolism? Stroke, 24, 31–4.10.1161/01.STR.24.1.31CrossRef Google Scholar PubMed

Roth, C. and Alli, O. (2015) Role of occlusive devices to prevent thromboembolism among persons with a patent foramen ovale and prior stroke. Curr Treat Options Neurol 17, 337.10.1007/s11940-014-0337-yCrossRef Google Scholar PubMed

Sacco, R., Ellenberg, J., Mohr, J., et al. 1989. Infarcts of undetermined cause: The NINCDS Stroke Data Bank. Ann Neurol, 25, 382–90.10.1002/ana.410250410CrossRef Google Scholar PubMed

Salem, D. and Thaler, D. 2013. Patent foramen ovale science: Keeping the horse in front of the cart. J Am Coll Cardiol Img, 62, 42–43.10.1016/j.jacc.2013.04.016CrossRef Google Scholar PubMed

Salzman, E. 1986. Venous thrombosis made easy. N Engl J Med, 314, 847–8.10.1056/NEJM198603273141309CrossRef Google Scholar PubMed

Saver, J. L., Carroll, J. D., Thaler, D. E., et al. 2017. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med, 377, 1022–32.10.1056/NEJMoa1610057CrossRef Google Scholar PubMed

Schneider, B., Hofmann, T., Justen, M. H., and Meinertz, T. 1995. Chiari’s network: normal anatomic variant or risk factor for arterial embolic events? J Am Coll Cardiol, 26, 203–10.10.1016/0735-1097(95)00144-OCrossRef Google Scholar PubMed

Schuchlenz, H., Weihs, W., Horner, S., and Quehenberger, F. 2000. The association between the diameter of a patent foramen ovale and the risk of embolic cerebrovascular events. Am J Med, 109, 456–62.10.1016/S0002-9343(00)00530-1CrossRef Google Scholar PubMed

Schuchlenz, H., Saurer, G., and Weihs, W. 2002a. Patent foramen ovale, atrial septal aneurysm, and recurrent stroke. N Engl J Med, 346, 1331–2; author reply 1331–2.Google Scholar PubMed

Schuchlenz, H., Weihs, W., Beitzke, A., et al. 2002b. Transesophageal echocardiography for quantifying size of patent foramen ovale in patients with cryptogenic cerebrovascular events. Stroke, 33, 293–6.10.1161/hs0102.100883CrossRef Google Scholar PubMed

Sondergaard, L., Kasner, S. E., Rhodes, J. F., et al. 2017. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med, 377, 1033–42.10.1056/NEJMoa1707404CrossRef Google Scholar PubMed

Spritzer, C., Arata, M., and Freed, K. 2001. Isolated pelvic deep venous thrombosis: Relative frequency as detected with MR imaging. Radiology, 219, 521–5.10.1148/radiology.219.2.r01ma25521CrossRef Google Scholar PubMed

Steiner, M., Di Tullio, M., Rundek, T., et al. 1998. Patent foramen ovale size and embolic brain imaging findings among patients with ischemic stroke. Stroke, 29, 944–8.10.1161/01.STR.29.5.944CrossRef Google Scholar PubMed

Stendel, R., Gramm, H., Schroder, K., Lober, C., and Brock, M. 2000. Transcranial Doppler ultrasonography as a screening technique for detection of a patent foramen ovale before surgery in the sitting position. Anesthesiology, 93, 971–5.10.1097/00000542-200010000-00016CrossRef Google Scholar PubMed

Stern, J., Abehsera, M., Grenet, D., et al. 2002. Detection of pelvic vein thrombosis by magnetic resonance angiography in patients with acute pulmonary embolism and normal lower limb compression ultrasonography. Chest, 122, 115–21.10.1378/chest.122.1.115CrossRef Google Scholar PubMed

Stollberger, C., Slany, J., Schuster, I., et al. 1993. The prevalence of deep vein thrombosis in patients with suspected paradoxical embolism. Ann Intern Med, 119, 461–5.10.7326/0003-4819-119-6-199309150-00003CrossRef Google Scholar PubMed

Tatlisumak, T. and Fisher, M. 1996. Hematologic disorders associated with ischemic stroke. J Neurol Sci, 140, 1–11.10.1016/0022-510X(96)00051-2CrossRef Google Scholar PubMed

Thaler, D., Di Angelantonio, D., Di Tullio, M., et al. 2013a. The Risk of Paradoxical Embolism (RoPE) Study: Initial description of the completed database. Int J Stroke, 8, 612–9.10.1111/j.1747-4949.2012.00843.xCrossRef Google Scholar PubMed

Thaler, D., Ruthazer, R., Di Angelantonio, E., et al. 2013b. Neuroimaging findings in cryptogenic stroke patients with and without patent foramen ovale. Stroke, 44, 675–80.10.1161/STROKEAHA.112.677039CrossRef Google Scholar PubMed

Thaler, D., Ruthazer, R., Weimer, C., et al. 2014a. Recurrent stroke predictors differ in medically treated patients with pathogenic vs. other PFOs. Neurology, 83, 221–6.10.1212/WNL.0000000000000589CrossRef Google Scholar PubMed

Thaler, D., Ruthazer, R., Weimer, C., et al. 2014b. Determinants of antithrombotic choice for patent foramen ovale in cryptogenic stroke. Neurology, 83, 1954–7.10.1212/WNL.0000000000001007CrossRef Google Scholar PubMed

The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. 1995. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med, 333, 1581–7.Google Scholar

The Publications Committee for the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. 1998. Low molecular weight heparinoid, ORG 10172 (Danaparoid), and outcome after acute ischemic stroke. JAMA, 279, 1265–72.Google Scholar

Thompson, T. and Evans, W. 1930. Paradoxical embolism. Q J Med, 23, 135–52.Google Scholar

Unno, N., Mitsuoka, H., Uchiyama, T., et al. 2002. Superficial thrombophlebitis of the lower limbs in patients with varicose veins. Surg Today, 32, 397–401.10.1007/s005950200061CrossRef Google Scholar PubMed

Vaidya, V., DeSimone, C., Asirvatham, S., et al. 2014. Implanted endocardial lead characteristics and risk of stroke or transient ischemic attack. J Interv Card Electrophysiol, 41, 31–8.CrossRef Google Scholar PubMed

Verlato, F., Zucchetta, P., Prandoni, P., et al. 1999. An unexpectedly high rate of pulmonary embolism in patients with superficial thrombophlebitis of the thigh. J Vasc Surg, 30, 1113–5.10.1016/S0741-5214(99)70051-0CrossRef Google Scholar PubMed

Ward, R., Jones, D., and Haponik, E. 1995. Paradoxical embolism. Chest, 108, 549–58.10.1378/chest.108.2.549CrossRef Google Scholar PubMed

Warlow, C., Ogston, D., and Douglas, A. 1976. Deep venous thrombosis of the legs after strokes. Br Med J, 1, 1178–83.Google Scholar PubMed

Webster, M., Chancellor, A., Smith, H., et al. 1988. Patent foramen ovale in young stroke patients. Lancet, 2, 11–2.Google Scholar PubMed

Wessler, B., Thaler, D., Ruthazer, R., et al. 2014. Transesophageal echocardiography in cryptogenic stroke and patent foramen ovale: Analysis of putative high-risk features from the risk of paradoxical embolism database. Circ Cardiovasc Imaging, 7, 125–31.Google Scholar PubMed

Wheeler, H. and Anderson, F. 1995. Diagnostic methods for deep vein thrombosis. Haemostasis, 25, 6–26.Google Scholar PubMed

Accessibility standard: Unknown

Why this information is here

This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.

Accessibility Information

Accessibility compliance for the PDF of this book is currently unknown and may be updated in the future.