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NEUROLOGY 1991;41:1902
© 1991 American Academy of Neurology

Transcranial Doppler ultrasound identifies patients with right-to-left cardiac or pulmonary shunts

M. I. Chimowitz, MD, J. J. Nemec, MD, T. H. Marwick, MBBS, R. J. Lorig, MD, PhD, A. J. Furlan, MD and E. E. Salcedo, MD

From the Departments of Neurology (Drs. Chimowitz and Furlan), Cardiology (Drs. Nemec, Marwick, and Salcedo), and Radiology (Dr. Lorig), Cleveland Clinic Foundation, Cleveland, OH.

We performed transcranial Doppler ultrasound (TCD) and transesophageal contrast echocardiography simultaneously in four patients. In one patient with a patent foramen ovale and another patient with pulmonary A-V fistulae, we detected micro air bubbles in the right middle cerebral artery three to five cardiac cycles after their appearance in the left atrium following intravenous injection of contrast. In two patients without right-to-left shunts, we did not detect air bubbles in the left atrium or middle cerebral artery following injection of contrast. These results show that TCD can identify patients with right-to-left cardiac or pulmonary shunts.

Address correspondence and reprint requests to Dr. Anthony J. Furlan, Department of Neurology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.

Received March 13, 1991. Accepted for publication in final form May 10, 1991.

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