case_images: PMC9124883_01
case_images: Brain MRI. (A) T1-weighted, (B) T2-weighted, and (C) fluid-attenuated inversion recovery (FLAIR) imaging were normal. MRI, magnetic resonance imaging.
case_images: fneur-13-855698-g0001.jpg
case_images: PMC9124883_01_fneur-13-855698-g0001.jpg
case_images: F1
case_images: Magnetic resonance imaging (MRI) scan of the brain showed no significant abnormalities (Figure 1).
case_images: cTCD: More than 25 microbubbles were detected after 2 s of Valsalva maneuver detecting from the left middle cerebral artery (LMCA) (single-channel and double depth) (blue arrow). cTCD, contrast transcranial Doppler echocardiography.
case_images: fneur-13-855698-g0002.jpg
case_images: PMC9124883_01_fneur-13-855698-g0002.jpg
case_images: F2
case_images: The contrast transcranial doppler echocardiography (cTCD) showed a latent and massive right-to-left shunt (RLS), that was, more than 25 microbubbles were detected using insonation of the left middle cerebral artery (LMCA) after the release of the Valsalva maneuver (Figure 2).