{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T09:54:19Z","timestamp":1777888459861,"version":"3.51.4"},"reference-count":25,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2012,7,19]],"date-time":"2012-07-19T00:00:00Z","timestamp":1342656000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Paradoxical embolism has been documented as a mechanism of cryptogenic embolic stroke. We investigated the frequency of right-to-left shunt in patients with cryptogenic embolic stroke and evaluated the factors associated with diffusion-weighted imaging (DWI) lesion pattern.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data on 157 consecutive patients with acute ischemic stroke because of presumed cryptogenic embolism. Agitated saline transcranial Doppler study was conducted in all patients to detect right-to-left shunt. We evaluated the association of the amount (microemboli \u226520 vs. \u226520) and activity (spontaneous vs. after Valsalva maneuver only) of right-to-left shunt with diffusion-weighted imaging lesion patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Right-to-left shunt was observed in 96 (61\u00b71%) patients. The multiplicity and distribution of diffusion-weighted imaging lesions did not differ depending on the amount and activity of right-to-left shunt. However, the size of diffusion-weighted imaging lesions differed depending on the amount of right-to-left shunt ( P = 0\u00b7019). Right-to-left shunt was more frequently observed in patients with small (&lt;1 cm) infarcts than in those with a large infarct (66\u00b77% vs. 45\u00b79%), and most patients with a larger amount of right-to-left shunt were found to have small infarcts on diffusion-weighted imaging (80%). The clinical characteristics, including Framingham stroke risk strategy, did not differ between the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our results indicate that the amount of right-to-left shunt determines the Diffusion-weighted imaging lesion patterns and suggest that mechanisms of stroke other than paradoxical mechanism may play an important role in patients with large cryptogenic embolic stroke.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/j.1747-4949.2012.00846.x","type":"journal-article","created":{"date-parts":[[2012,7,20]],"date-time":"2012-07-20T17:39:30Z","timestamp":1342805970000},"page":"657-662","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":19,"title":["Association between the Amount of Right-to-Left Shunt and Infarct Patterns in Patients with Cryptogenic Embolic Stroke: A Transcranial Doppler Study"],"prefix":"10.1177","volume":"8","author":[{"given":"Ji Won","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Neurology, Stroke and Cerebrovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suk Jae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stroke and Cerebrovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cindy W","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stroke and Cerebrovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chang-Hyun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Division for Neurorehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kun Woo","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stroke and Cerebrovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soo Kyoung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stroke and Cerebrovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yun-Hee","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Division for Neurorehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oh Young","family":"Bang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stroke and Cerebrovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South 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