{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:03:46Z","timestamp":1756425826681,"version":"3.44.0"},"reference-count":30,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,11,5]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:p>A man in his late 30s with gait difficulty, dysarthria, impaired consciousness and polyuria was diagnosed with left thalamic infarction. Hypercalcaemia (3.52\u2009mmol\/L (2.15\u20132.52)), high intact-parathyroid hormone (i-PTH) levels (88.8\u2009pmol\/L (1.1\u20136.9)) and high D-dimer levels (14.7\u2009mg\/L (&lt;1.0)) were identified, followed by a positive microbubble test on transesophageal echocardiogram, suggesting high-risk patent foramen ovale (PFO) for ischaemic stroke. Paradoxical cerebral embolism via PFO, complicated by a hypercoagulable state and hypercalcemic dehydration, was considered. Polyglandular parathyroid hyperplasia, plus radiolucent mandibular tumours, suggested multiple endocrine neoplasia type 1 (MEN1) or hyperparathyroidism-jaw tumour syndrome. Genetic testing confirmed MEN1. Treatment was 24\u2009mg of oral evocalcet and total parathyroidectomy with forearm autotransplantation, resulting in improved serum calcium and i-PTH levels. Finally, he underwent transcatheter PFO closure. We emphasise careful, etiological pursuit in young-onset stroke and the usefulness of genetic testing in differentiating hyperparathyroidism associated with mandibular tumours.<\/jats:p>","DOI":"10.1136\/bcr-2024-261601","type":"journal-article","created":{"date-parts":[[2024,11,24]],"date-time":"2024-11-24T13:05:19Z","timestamp":1732453519000},"page":"e261601","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Paradoxical cerebral embolism caused by patent foramen ovale in a patient with multiple endocrine neoplasia type 1 and severe primary hyperparathyroidism"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8780-8536","authenticated-orcid":false,"given":"Takaaki","family":"Matsuda","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism, University of Tsukuba, Tsukuba, Ibaraki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1425-7790","authenticated-orcid":false,"given":"Yoshinori","family":"Osaki","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, University of Tsukuba, Tsukuba, Ibaraki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Motohiro","family":"Sekiya","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, University of Tsukuba, Tsukuba, Ibaraki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5562-5572","authenticated-orcid":false,"given":"Hitoshi","family":"Shimano","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, University of Tsukuba, Tsukuba, Ibaraki, 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