Paradoxical Embolus Across Atrial Septal Defect and Posterior Circulation Infarct in Neurosurgical Patients

ABSTRACT Paradoxical embolism through a patent foramen ovale or atrial septal defect is increasingly recognized in association with embolic strokes, with the advent of modern echocardiography. The authors describe two neurosurgical cases with such an anomaly that suffered nonfatal embolic stroke in...

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Bibliographic Details
Published in:International journal of neuroscience 2010-05, Vol.120 (7), p.516-520
Main Authors: Furtado, Sunil V., Venkatesh, Prasanna K., Murthy, Ganesh K., Furtado, Arul D., Hegde, Alangar S
Format: Article
Language:English
Subjects:
Adult
air embolism
atrial septal defect
Brain Infarction - diagnosis
Brain Infarction - etiology
Brain Infarction - surgery
Cerebellar Diseases - diagnosis
Cerebellar Diseases - etiology
Cerebellar Diseases - surgery
cerebellum
infarct
Embolism, Air - diagnosis
Embolism, Air - prevention & control
Embolism, Air - surgery
Female
Heart Septal Defects, Atrial - complications
Heart Septal Defects, Atrial - diagnosis
Heart Septal Defects, Atrial - surgery
Humans
Intracranial Embolism - complications
Intracranial Embolism - diagnosis
Intracranial Embolism - surgery
Male
Middle Aged
Neurosurgical Procedures - standards
paradoxical embolism
stroke
Vertebrobasilar Insufficiency - diagnosis
Vertebrobasilar Insufficiency - etiology
Vertebrobasilar Insufficiency - surgery
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Summary:ABSTRACT Paradoxical embolism through a patent foramen ovale or atrial septal defect is increasingly recognized in association with embolic strokes, with the advent of modern echocardiography. The authors describe two neurosurgical cases with such an anomaly that suffered nonfatal embolic stroke in the cerebellum. The patients developed posterior inferior cerebellar artery infarcts, which were managed conservatively and had no neurological deficits. They evaluate possible factors for emboli to occur in a perioperative neurosurgical setting and provide a brief review of literature on preoperative management of patients with this cardiac defect. Closure of cardiac shunts is warranted before nonemergent neurosurgical operations. During emergency craniotomies, proper precautions should be taken to reduce the incidence of venous air embolism and paradoxical embolism.
ISSN:0020-7454
1563-5279
1543-5245
DOI:10.3109/00207451003760072