BACKGROUND AND PURPOSE: Although right-to-left shunt (RLSh) has been reported to be significantly more frequent in young @entity64 @entity1 with cryptogenic @entity64 , its relevance in a nonselected population of acute @entity385 is not well known. The aim of this study was to determine the importance of the RLSh magnitude as a risk factor for @entity64 in nonselected @entity1 . METHODS: Two hundred eight @entity1 hospitalized consecutively with transient @entity63 attack or acute @entity385 and 100 healthy control subjects were studied. Transcranial Doppler ultrasonography (TCD) was performed in both @entity2500 ( @entity2500 ) after intravenous application of agitated saline solution. The magnitude of RLSh was quantified by counting the number of signals in 1 MCA during a Valsalva maneuver. RLSh was classified as "no shunt," "small" (< 10 signals), and "large" (> 10 signals), with the latter including the "shower" (> 25 signals) and "curtain" (uncountable signals) patterns. Extensive investigations, including contrast transesophageal echocardiography, were carried out on @entity1 diagnosed as suffering from @entity64 of an uncertain etiology. The importance of RLSh for @entity64 was assessed by logistic regression analysis. RESULTS: Contrast TCD detected a large RLSh in 40 (19.7%) @entity1 and in 21 (21%) control subjects, all with cardiac RLSh characteristics. A large RLSh was present in 4.7% of @entity64 , 10.5% of @entity64 , 15.4% of @entity64 , and 45.3% of cryptogenic @entity64 (P<0.001). Although the overall frequency of RLSh was not significantly different between @entity1 and control subjects, the detection of curtain or shower patterns by contrast TCD was associated with a higher risk of @entity64 (odds ratio, 3.5; 95% confidence interval, 1.29 to 9.87), particularly with cryptogenic @entity64 (odds ratio, 12.4; 95% confidence interval, 4.08 to 38.09) after adjustment for concomitant vascular risk factors. CONCLUSIONS: It is essential to quantify RLSh by contrast TCD during the Valsalva maneuver given that only those with shower and curtain patterns are associated with a higher risk of @entity385 in a nonselected population.

The need to quantify right-to-left shunt in acute XXXX : a case-control study.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity64 :: ('MESH:D020521', 'Disease') :: ['strokes', 'cardioembolic strokes', 'stroke', 'atherothrombotic strokes', 'lacunar strokes'] @entity63 :: ('MESH:D007511', 'Disease') :: ['ischemic'] @entity2500 :: ('MESH:D020244', 'Disease') :: ['MCAs', 'middle cerebral arteries'] @entity385 :: ('MESH:D002544', 'Disease') :: ['ischemic stroke', 'cerebral infarction']
@entity385 :: (MESH:D002544,Disease) :: ['ischemic stroke']
