A 69-year-old man was admitted to the hospital with right hemiparesis and global aphasia. Perfusion computed tomography imaging revealed ischemic penumbra in the middle cerebral artery territory. Angiography showed left middle cerebral artery occlusion. Mechanical thrombectomy with one pass was performed, and successful recanalization was obtained. Embolic material was retrieved; it contained tumor fragments with atypical keratinizing squamous cell carcinoma. Contrast computed tomography imaging indicated tumor invasion into the superior vena cava, and contrast transcranial Doppler indicated the presence of a right-to-left shunt after the Valsalva maneuver. We diagnosed the patient with acute ischemic stroke of large vessel occlusion due to venous invasion of esophageal carcinoma via a right-to-left shunt. To the best of our knowledge, this is the first case of embolic occlusion resulting from an extracardiac tumor via a right-to-left shunt. Contrast transcranial Doppler potentially detects right-to-left shunts in patients who cannot undergo transesophageal echocardiography.

一名69岁的男子因右偏瘫和全球性失语症入院。灌注计算机断层扫描成像显示大脑中动脉区域有缺血性半影​​。血管造影显示左中脑动脉闭塞。进行了一次机械血栓切除术，并获得了成功的再通。栓塞材料被取出；它含有非典型角化鳞状细胞癌的肿瘤碎片。对比计算机断层扫描显像表明肿瘤浸润到上腔静脉中，而对比经颅多普勒显示在瓦尔萨尔瓦手术后从右向左分流。我们通过右向左分流术诊断为食管癌静脉浸润引起的急性大血管闭塞性缺血性卒中。据我们所知，这是第一例由右至左分流的心外肿瘤引起的栓塞闭塞。对比经颅多普勒检查可能会在无法接受经食道超声心动图检查的患者中检测出从右向左的分流。