Abstract
45-year-old woman presented with dizziness, nausea and sudden visual loss, symptoms had appeared for 3 hours. There was no notable past history. Diagnosis: acute ischemic stroke in right parietotemporal lobe at 3rd hour, we started fibrinolytic therapy and patient recovered without any complications. Workup to find the cause of stroke included: 24-hour holter electrocardiography, Doppler ultrasonography of carotid arteries, and echocardiography. All results came back normal, we then performed transesophageal echocardiography and found some echogenic bubbles from the superior vena cava to the left atrium after 3 – 4 cardiac cycles. We suspected an indirect shunt and ordered pulmonary blood vessels MSCT, the result showed pulmonary arteriovenous malformation, so we indicated arteriovenous embolization. The challenge in this case was that we could not find the stroke cause as well as measures to prevent recurrent stroke.
