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.

Journal of Neurosonology 3(1):12-15, 2011
Key Words: Pulmonary arteriovenous malformation, Transcranial Doppler, Microembolic signal, Brain infarction