Rinshō shinkeigaku = Clinical neurology
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The right-to-left shunt from pulmonary arteriovenous fistula (P-AVF) with Rendu-Osler-Weber (R-O-W) disease can cause paradoxical brain embolism. However, it has remains unclear whether the isolated P-AVF without Rendu-Osler-Weber (R-O-W) disease is associated with ischemic stroke, in particular, paradoxical brain embolism. Our group previously reported a case with paradoxical brain embolism associated with isolated P-AVF without R-O-W disease in 1996. Furthermore, in 1999, we reported that transcranial Doppler (TCD) with saline contrast medium was useful for identifying the presence of P-AVF as a right-to-left shunt. Therefore, when we have an embolic stroke patient with unknown source, we have performed TCD for detecting P-AVF since 1998. The aim of this study was to investigate the frequency of brain infarction associated with isolated P-AVF without R-O-W disease and to evaluate clinical characteristics including a previously reported case, and to elucidate the stroke mechanism. ⋯ The isolated P-AVF without R-O-W disease can cause paradoxical brain embolism. Catheter embolization of P-AVF may be effective in prevention for recurrent stroke. We should not overlooked isolated P-AVF as a right-to-left shunt in embolic stroke patients with unknown etiology.