Simultaneous Multifocal Paradoxical Embolism in an Elderly Patient with Patent Foramen Ovale: A Case Report.

About one-third of ischemic strokes may be associated with a patent foramen ovale (PFO). This article presents an unusual case of a 68-year-old woman with simultaneous paradoxical thrombo-embolization to different systemic sites. The patient presented initially with visual deficits and intracerebellar hemorrhage but was found to have concomitant saddle pulmonary embolism, sub-acute cerebral infarction with focal neurological deficits, and thromboembolism to the superior mesenteric artery (SMA) that resulted in an ischemic bowel. The unifying diagnosis was paradoxical embolism through a PFO and an atrial septal aneurysm with high-risk features. The patient underwent percutaneous closure of the PFO with an Amplatzer device.