| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Departments of Neurology (Drs. Klötzsch and Berlit) and Internal Medicine (Dr. Janßen), Alfried-Krupp-Hospital, Essen, Germany.
Patent foramen ovale (PFO) is increasingly recognized in association with cryptogenic stroke. Using transesophageal echocardiography (TEE) and transcranial Doppler sonography with ultrasonic contrast medium (contrast-TCD), we evaluated the frequency of a PFO as the fundamental condition of paradoxical embolism in 111 patients after cerebral ischemia. There was a right-left shunt in 50 patients (45%) with TEE. In 31 of 40 patients with stroke of unknown etiology, a PFO was the only detectable finding associated with cerebral ischemia. Using TEE as the "gold standard," the sensitivity of contrast-TCD was 91.3%, specificity 93.8%, and the overall accuracy 92.8%. Contrast-TCD failed to detect a right-left shunt in four patients, but there were four other patients with negative TEE and positive contrast-TCD. We conclude that contrast-TCD is a highly sensitive method for detecting a right-left shunt. Its advantages are low cost, its ability to detect single contrast-medium embolism, and control of the Valsalva maneuver by observing the decrease of cerebral blood flow. Evidence of PFO in cryptogenic stroke should prompt a search for a subclinical venous thrombosis as the embolic source.
Address correspondence and reprint requests to Dr. Christof Klötzsch, Department of Neurology, Alfried-Krupp-Hospital, 45117 Essen, Germany.
Received December 13, 1993. Accepted in final form March 15, 1994.
This article has been cited by other articles:
|
|
 |
|
  M. Del Sette, L. Dinia, D. Rizzi, A. Sugo, B. Albano, and C. Gandolfo Diagnosis of Right-to-Left Shunt With Transcranial Doppler and Vertebrobasilar Recording Stroke, August 1, 2007; 38(8): 2254 - 2256. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. I.I. Soliman, M. L. Geleijnse, F. J. Meijboom, A. Nemes, O. Kamp, P. Nihoyannopoulos, N. Masani, S. B. Feinstein, and F. J. Ten Cate The use of contrast echocardiography for the detection of cardiac shunts Eur J Echocardiogr, June 1, 2007; 8(3): s2 - s12. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D J H McCabe and R D Rakhit Antithrombotic and interventional treatment options in cardioembolic transient ischaemic attack and ischaemic stroke J. Neurol. Neurosurg. Psychiatry, January 1, 2007; 78(1): 14 - 24. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Y. Kassab, A. Majid, M. U. Farooq, H. Azhary, L. A. Hershey, E. M. Bednarczyk, D. F. Graybeal, and M. D. Johnson Transcranial Doppler: An Introduction for Primary Care Physicians J Am Board Fam Med, January 1, 2007; 20(1): 65 - 71. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Souteyrand, P. Motreff, J.-R. Lusson, R. Rodriguez, E. Geoffroy, C. Dauphin, J.-Y. Boire, D. Lamaison, and J. Cassagnes Comparison of transthoracic echocardiography using second harmonic imaging, transcranial Doppler and transesophageal echocardiography for the detection of patent foramen ovale in stroke patients Eur J Echocardiogr, March 1, 2006; 7(2): 147 - 154. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. L Schmitz, S. C Faulkner, C. E Johnson, J. L Tucker, M. Imamura, S B. Greenberg, and J. J Drummond-Webb Cardiopulmonary bypass for adults with congenital heart disease: pitfalls for perfusionists Perfusion, January 1, 2006; 21(1): 45 - 63. [Abstract] [PDF]
|
|
|
|
 |
|
 S. Homma and R. L. Sacco Patent Foramen Ovale and Stroke Circulation, August 16, 2005; 112(7): 1063 - 1072. [Full Text] [PDF]
|
|
|
|
 |
|
 B. Draganski, W. Blersch, S. Holmer, H. Koch, A. May, U. Bogdahn, T. Holscher, and F. Schlachetzki Detection of Cardiac Right-to-Left Shunts by Contrast-Enhanced Harmonic Carotid Duplex Sonography J. Ultrasound Med., August 1, 2005; 24(8): 1071 - 1076. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. P. Mohr and S. Homma Patent Cardiac Foramen Ovale: Stroke Risk and Closure Ann Intern Med, November 4, 2003; 139(9): 787 - 788. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Daly, S. Hutchinson, C. McCollum, Y.-H. Kim, J.-S. Kim, and S.-W. Oh Etiology of Mental Status Changes in Patients After Total Hip Arthroplasty: Hypoxemia or Paradoxical Embolization of Fat or Bone Marrow? J. Bone Joint Surg. Am., May 1, 2003; 85(5): 967 - 967. [Full Text] [PDF]
|
|
|
|
 |
|
 W. K. Blersch, B. M. Draganski, S. R. Holmer, H. J. Koch, F. Schlachetzki, U. Bogdahn, and T. Holscher Transcranial Duplex Sonography in the Detection of Patent Foramen Ovale Radiology, December 1, 2002; 225(3): 693 - 699. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. Droste, S. Lakemeier, T. Wichter, J. Stypmann, R. Dittrich, M. Ritter, M. Moeller, M. Freund, and E. B. Ringelstein Optimizing the Technique of Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts Stroke, September 1, 2002; 33(9): 2211 - 2216. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Arquizan, J. Coste, P.-J. Touboul, and J.-L. Mas Is Patent Foramen Ovale a Family Trait? : A Transcranial Doppler Sonographic Study Stroke, July 1, 2001; 32(7): 1563 - 1566. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Kerr, T. Buck, K. Chia, C. M. Chow, E. Fox, R. A. Levine, and M. H. Picard Transmitral Doppler: a new transthoracic contrast method for patent foramen ovale detection and quantification J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1959 - 1966. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Overell, I. Bone, and K. R. Lees Interatrial septal abnormalities and stroke: A meta-analysis of case-control studies Neurology, October 24, 2000; 55(8): 1172 - 1179. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. Droste, K. Silling, J. Stypmann, M. Grude, V. Kemeny, T. Wichter, K. Kuhne, and E. B. Ringelstein Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts : Time Window and Threshold in Microbubble Numbers Stroke, July 1, 2000; 31(7): 1640 - 1645. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. J. Kirkham, M. Prengler, D. K.M. Hewes, and V. Ganesan Risk Factors for Arterial Ischemic Stroke in Children J Child Neurol, May 1, 2000; 15(5): 299 - 307. [Abstract] [PDF]
|
|
|
|
|
|
H. P. Kuhl, R. Hoffmann, M. W. Merx, A. Franke, C. Klotzsch, W. Lepper, T. Reineke, J. Noth, and P. Hanrath Transthoracic echocardiography using second harmonic imaging: Diagnostic alternative to transesophageal echocardiography for the detection of atrial right to left shunt in patients with cerebral embolic events J. Am. Coll. Cardiol., November 15, 1999; 34(6): 1823 - 1830. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. Droste, J.-U. Kriete, J. Stypmann, M. Castrucci, T. Wichter, R. Tietje, B. Weltermann, P. Young, and E. B. Ringelstein Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts : Comparison of Different Procedures and Different Contrast Agents Stroke, September 1, 1999; 30(9): 1827 - 1832. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Schwarze, D. Sander, C. Kukla, I. Wittich, V. L. Babikian, and J. Klingelhofer Methodological Parameters Influence the Detection of Right-to-Left Shunts by Contrast Transcranial Doppler Ultrasonography Stroke, June 1, 1999; 30(6): 1234 - 1239. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. Droste, M. Reisener, V. Kemeny, R. Dittrich, G. Schulte-Altedorneburg, J. Stypmann, T. Wichter, and E. B. Ringelstein Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts : Reproducibility, Comparison of 2 Agents, and Distribution of Microemboli Stroke, May 1, 1999; 30(5): 1014 - 1018. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Serena, T. Segura, M. J. Perez-Ayuso, J. Bassaganyas, A. Molins, and A. Davalos The Need to Quantify Right-to-Left Shunt in Acute Ischemic Stroke : A Case-Control Study Stroke, July 1, 1998; 29(7): 1322 - 1328. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ay, F. S. Buonanno, S. A. Abraham, J. P. Kistler, and W. J. Koroshetz An Electrocardiographic Criterion for Diagnosis of Patent Foramen Ovale Associated With Ischemic Stroke Stroke, July 1, 1998; 29(7): 1393 - 1397. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. D. Cheitlin, J. S. Alpert, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, T. W. Davidson, J. L. Davis, P. S. Douglas, L. D. Gillam, et al. ACC/AHA Guidelines for the Clinical Application of Echocardiography : A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography) Developed in Collaboration With the American Society of Echocardiography Circulation, March 18, 1997; 95(6): 1686 - 1744. [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
