Aortogenic Embolism and Paradoxical Embolism due to Patent Foramen Ovale and Deep Vein Thrombosis(1. Systemic Complications Neurosurgeons need to Know,<SPECIAL ISSUES>Stroke as a Systemic Vascular Disease)

Abstract

Aortogenic and paradoxical embolisms have been recognized as possible causes of cryptogenic stroke. For the diagnosis of both conditions, transesophageal echocardiography has been widely used in the routine examination of ischemic stroke patients. An aortic IMT>4mm, mobile plaques and ulcers were defined as complex lesions and could be a potential risk for ischemic stroke. For medical treatment of aortogenic embolism, combination of statin and anti-thrombotic therapy (either antiplatelet or anticoagulation therapy) is recommended. For diagnosis of paradoxical embolism, confirmation of a right-to-left shunt through the patent foramen ovale is not sufficient enough because almost 20% of healthy adults have a right-to-left shunt. A diagnosis of deep vein thrombosis or pulmonary embolism is also required. For cryptogenic stroke patients with patent foramen ovale, antiplatelet therapy is usually recommended to prevent a recurrent event while warfarin is reasonable for high-risk patients who have other indications for anticoagulation such as venous thrombosis.