Bubbles in the Brain: A Rare Complication Following Transthoracic Echocardiography.

With nearly 700,000 cases every year, ischemic stroke represents the third leading cause of death in the United States.1,2 Nearly thirty percent of all ischemic strokes are due to embolism.3 A standard component of every stroke work-up at most institutions, echocardiography is vital not only for diagnosis but also for prevention and treatment of cardiac sources of embolism. Visualization of right-to-left shunting is often contrast-enhanced with micro bubbles created by mixing saline with air, a so-called "bubble study." We present a case of an 89-year-old woman who suffered cerebral air embolism and massive infarction following a routine bubble Transthoracic Echocardiogram.