[50-year-old patient with dyspnea, dizziness, palpitations and brief sensory aphasia].

After a syncope, a 50 years old female patient was administered with an incomplete central facial paralysis on the left side combined with dyspnea, tachycardia, and hypotension as well as a systolic nurmur over the tricuspid valve. One week before, a vein stripping of the left long saphenous vein had been undertaken. By doppler-ultrasound, a thrombosis of the left tibial veins could be found as the cause of the pulmonary embolism. Additionally, the echocardiogram showed a relative tricuspid insufficiency and a floating atrial septum combined with an enlarged right atrium as an expression of the pulmonary hypertension. The incomplete central facial paralysis must be due to a paradox embolism in the cerebrovascular circulation as a result of an open foramen ovale. Under a therapy with high-dose heparin, all findings receded totally within one week.