This Article Full Text Full Text (PDF) All Versions of this Article: 39/10/e150    most recent STROKEAHA.108.527093v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mazzucco, S. Articles by Rizzuto, N. Search for Related Content PubMed PubMed Citation Articles by Mazzucco, S. Articles by Rizzuto, N.

(Stroke. 2008;39:e150.)
© 2008 American Heart Association, Inc.

Letters to the Editor

Right-to-Left Shunt in CADASIL Patients: A Comorbidity Factor?

Department of Neurological and Visual Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy

Gian Paolo Anzola, MD

Service of Neurology, Sant’Orsola Hospital FBF, Brescia, Italy

Nicolò Rizzuto, MD

Department of Neurological and Visual Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

In 2001 Angeli et al¹ reported a remarkably high prevalence of right to left shunt (RLS) in a single CADASIL pedigree, suggesting "a possible association between CADASIL and RLS". Surprisingly, and notwithstanding the large volume of data building up on CADASIL pathogenesis and diagnosis, no further data has followed this first and only publication on this topic up to now. This is why we read with much interest the article from Zicari et al,² reporting on a very high prevalence of RLS (71%) in a sample of 21 patients with CADASIL. However, some concerns have to be issued.

The authors stated that "the high prevalence of RLS in CADASIL patients might not be a coincidence but may rather suggest a common genetic origin of CADASIL and the cardiac septal defect". From a methodological point of view, this hypothesis should be based on the anatomic demonstration of the source of the RLS itself. Contrast enhanced TCD is highly sensitive in RLS detection when compared to transesophageal echocardiograhy, but it cleary lacks specificity in differentiating intracardiac shunts (namely, patent foramen ovale [PFO]) versus pulmonary ones (pulmonary fistulas).³ Transesophageal echocardiograhy confirmation of a PFO would have been required to support the above mentioned hypothesis.

Secondly, the lack of information about patients’ genotype makes the interpretation of prevalence data difficult.

Carrying out a study on CADASIL comorbidity factors and genotype-phenotype relations, Mazzucco et al⁴ looked at the prevalence of RLS in a group of 16 CADASIL patients, with a range of . . . [Full Text of this Article]

This article has been cited by other articles:

				S. Mazzucco, G. P. Anzola, and N. Rizzuto Methodological Issues in Right-to-Left Shunt Detection in CADASIL Patients Stroke, July 1, 2009; 40(7): e509 - e509. [Full Text] [PDF]