• John A Batsis, Iasmina M Craici, and David A Froehling.
• Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
• Neurocrit Care. 2005 Jan 1; 2 (2): 185-8.

IntroductionParadoxical embolus should be suspected in young patients with cerebrovascular events who do not have any vascular risk factors. There is significant controversy as to how best to treat his phenomenon.MethodsA case observation in a tertiary care center.ResultsA 46-year-old was admitted to the intensive care unit (ICU) for unresponsiveness secondary to diabetic ketoacidosis and acute respiratory distress syndrome. He was intubated, and central access was obtained through the right internal jugular vein. Initial computed tomography (CT) scan of his brain was unremarkable. Four days later, he suddenly became increasingly unresponsive. Repeat CT scan of the brain revealed large bilateral posterior infarcts. Transesophegeal echocardiogram revealed a patent foramen ovale (PFO), and Doppler ultrasound revealed a thrombus in the low right jugular vein. He was anticoagulated for 3 months with no intervention for his PFO.ConclusionThis case emphasizes the potential complications of the use of central lines in ICUs, particularly in patients with diabetic ketoacidosis in whom sluggish blood flow may predispose to a procoagulant state.

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