The successful surgical treatment of a paradoxical embolus to the carotid bifurcation

Paradoxical embolism is a rare cause of ischemic stroke. We report the case of a 67-year-old man who had a saddle embolus to the carotid bifurcation s uccessfully treated with emergency embolectomy. Transesophageal echocardiog ram revealed a large patent foremen ovale and an easily demonstrable right- to-left shunt. Subsequent investigations revealed proximal deep venous thro mbosis in the left femoral and popliteal veins and multiple pulmonary embol i. Long-term anticoagulation was instituted for the diagnosis of paradoxica l embolism. The patient's recovery was uneventful, and he remained neurolog ically intact. A literature review emphasizes the role of transesophageal e chocardiography and suggests that paradoxical embolism may be a more common cause of stroke than previously thought.