Infarction of cerebellum vermis attributed to a right-to-left shunt by pulmonary arteriovenous malformation: a case report.

Abstract

Abstract Objectives: We reported this case to remind neurologists that pulmonary right-to-left shunt is one of the causes of paradoxical embolism. Methods: A 47-year-old woman was diagnosed with infarction of cerebellum vermis by MRI. Atheromatous, immunological, infectious and hypercoagulable abnormality was negated. A doubtful pulmonary arteriovenous malformation (PAVM) was accidentally found in the process of CT angiography of subclavian arteries. Results: Then the pulmonary angiography confirmed the existence of PAVM in her left pulmonary lobe. Meanwhile, the bubble contrast study with transcranial Doppler found bubble signals passing her middle cerebral artery. Discussion: Other than intracardiac, but pulmonary right-to-left shunt can induce embolic stroke.