Serial contrast saline transcranial Doppler examination in a patient with paradoxical brain embolism associated with pulmonary embolism

We report a patient with paradoxical brain embolism due to patent foramen ovale (PFO) associated with pulmonary embolism (PE). The number of microembolic signals, as detected by contrast saline transcranial Doppler (c-TCD) exam, drastically decreased with improvement of increased right atrial pressure due to PE. In a patient with paradoxical brain embolism associated with PE, c-TCD may be useful for both diagnosis of the presence of right-to-left shunting and evaluation of cardio-pulmonary circulation.