A Case of Stroke Patient with Concomitant Pulmonary Arteriovenous Malformation and Patent Foramen Ovale: Transcranial Doppler Findings

Case Report

Journal of Neurosonology 2011;3(1):12-15.

폐동정맥기형과 난원공 개존증이 동반된 뇌경색:두개경유 도플러초음파검사 소견

Abstract

Pulmonary arteriovenous malformation (AVM) and patent foramen ovale (PFO) have been considered as the potential source of embolism through the right to left shunt in stroke patients. We report a stroke patient who had concomitant pulmonary AVM and PFO. They are characterized as the findings of transcranial Doppler (TCD) sonographic examination. A 37-year-old woman was diagnosed as ischemic stroke in her right occipital lobe. TCD monitoring with agitated-saline contrast revealed curtain-type microembolic signals (MES). MES last for 6 minutes from the infusion of agitated-saline. Endovascular closure of pulmonary AVM changed the TCD findings into scanty MES, provoked only after Valsalva’s maneuver with short duration. We suggest that TCD with agitated-saline contrast is a useful diagnosis-tool for embolic stroke caused by both intracardiac and extracardiac shunt. Furthermore, TCD findings can be helpful to differentiate between pulmonary AVM and PFO.