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Year : 2010  |  Volume : 56  |  Issue : 3  |  Page : 206-208

Paradoxical embolism causing stroke and migraine

Department of Cardiology, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester, United Kingdom

Correspondence Address:
S Nightingale
Department of Cardiology, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester
United Kingdom
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0022-3859.68630

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This case report describes a lady who underwent investigations as a part of a clinical study. A 32-year-old woman with a history of episodes of severe migraine with aura, deep vein thrombosis and recurrent epistaxis, presented with two episodes of stroke with no particular cause evident on routine investigations. A contrast echocardiogram demonstrated a patent foramen ovale (PFO). She was found to be positive for the Factor V Leiden mutation. The PFO was closed percutaneously. However, a substantial right to left shunt of 14% persisted. Pulmonary angiography revealed multiple arterio-venous malformations (AVMs) and she was diagnosed with hereditary hemorrhagic telangiectasia. The AVMs were embolized and she has had no further cerebral events. Interestingly, her episodes of 'migraine' have also improved dramatically following the closure of the PFO and the embolization of the AVMs. This case demonstrates the complex relationship between right to left shunts, cryptogenic stroke and migraine.


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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow