case_images: PMC10811204_01
case_images: Brain magnetic resonance imaging. Diffusion weighted images (A) and fluid-attenuated inversion recovery weighed images (B) revealed that acute multiple cerebral infarction was present in bilateral basal ganglia and corona radiate. Magnetic resonance angiography of cranial (C) and carotid arteries (D) showed no significant stenosis of the cerebral, carotid, or vertebral arteries.
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case_images: F1
case_images: Brain magnetic resonance imaging (MRI) revealed multiple acute cerebral infarctions in the bilateral basal ganglia and corona radiata (Figure 1), and magnetic resonance angiography (MRA) showed no significant stenosis of the cerebral, carotid, or vertebral arteries.
case_images: (A) Skin biopsy of the right lower limb. (B) Bone marrow biopsy.
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case_images: F2
case_images: Evaluation of a skin biopsy specimen obtained from the right lower extremity revealed histopathological changes indicative of eosinophilic vasculitis (Figure 2A). A bone marrow biopsy revealed relatively pronounced eosinophilia [eosinophilic granulocytosis (34.0%)] (Figure 2B).
case_images: (A) c-TCD revealed a grade 2 right-to-left shunt during the valsalva maneuver. (B) c-TTE revealed a large number of microbubbles in the left-sided chambers during the Valsalva maneuver. (C) c-TEE revealed a large number of microbubbles in the left-sided chambers during the Valsalva maneuver.
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case_images: F3
case_images: Contrast-enhanced transcranial Doppler (c-TCD) revealed a grade 2 right-to-left shunt (24 microbubbles in the middle cerebral artery during the Valsalva maneuver) (Figure 3A). Contrast-enhanced transthoracic echocardiography (c-TTE) in this case revealed a moderate number of microbubbles in the left-sided chambers at rest and a large number of microbubbles during the Valsalva maneuver (Figure 3B). Contrast-enhanced TEE (c-TEE) revealed a moderate-to-large number of microbubbles in the left atrium at rest and a large number of microbubbles during the Valsalva maneuver (Figure 3C).
case_images: (A) Optical coherence tomography inside the tunnel of PFO. A white thrombus was observed (white arrow). (B) PFO closure was performed step by step.
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case_images: F4
case_images: A white thrombus was observed in the tunnel (Figure 4A). We subsequently performed successful PFO occlusion using a 18/25 mm PFO occluder (Abbott, USA) (Figure 4B).