PMC6598109_01
The main observation results in patient case 1: (A) MRI of the right basal ganglia and right occipital lobe. (B) Magnetic resonance angiography (MRA) of neck and intracranial arteries. (C) c-TCD test in the fourth cardiac cycle after Valsalva action. (D) TEE examination.
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Hyperintensity of the right basal ganglia and right occipital lobe using fluid-attenuated inversion recovery (FLAIR) sequences were revealed by brain magnetic resonance imaging (MRI) (Fig. 1A). Performed 48 hours later, Magnetic resonance angiography (MRA) of neck and intracranial arteries exhibited normal (Fig. 1B). Detected in the fourth cardiac cycle after Valsalva action were a large number of microembolic signals (rain curtain shape, Fig. 1C). TEE examination showed PFO (Fig. 1D).
PMC6598109_02
The main observation results in patient case 2: (A) Brain MRI of left pontine by FLAIR sequences. (B) Conducting Computed Tomography Angiography (CTA) of neck and intracranial arteries. (C) c-TCD test in the 8th cardiac cycle after Valsalva action.
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Abnormal long signal of the left pontine was showed in brain MRI by FLAIR sequences (Fig. 2A). Conducting Computed Tomography Angiography (CTA) of neck and intracranial arteries revealed limited narrow on the right anterior cerebral artery A2 segment and the left anterior cerebral artery segment A3 and limited moderate stenosis on the initial segment of the right vertebral artery (Fig. 2B). During the 8th cardiac cycle (rain curtain) after Valsalva action, a large number of embolus signals were revealed (Fig. 2C).
PMC6598109_03
The main observation results in patient case 3: (A) Brain MRI of bilateral medulla. (B) MRA of basal artery. (C) c-TCD test in the 4th cardiac cycle after Valsalva action. (D) TEE examination.
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Brain MRI showed bilateral medulla medial infarction (Fig. 3A), while MRA demonstrated basal artery ranging from local mild to moderate stenosis (Fig. 3B). After Valsalva action, a large number of "rain-like" micro-embolus signals appeared in the fourth cardiac cycle (Fig. 3C). TEE examination of the patent foramen ovale existed (Fig. 3D).