Paradoxical cerebral embolism secondary to pulmonary arteriovenous fistula.

including brainstem signs, headache, and absence of hemorrhage on head CT scan, together with an opacified basilar artery suggestive of basilar artery thrombosis.Any effective treatment of basilar artery occlusion is welcome. Our experience, together with Fisher's report of turning the patient upside down, suggests that the use of heparin in conjunction with mechanical factors (i.e., gravity or shaking, which we implemented) may be more beneficial than anticoagulation alone. The presence of clot, suggested by the cerebral angiogram, may have made mechanical "treatment" more likely to be successful, perhaps by dislodging the clot and enhancing clot dissolution. Obviously our case is anecdotal and uncontrolled; however, this approach warrants further investigation in a larger number of patients to determine if manipulating other factors of the vertebrobasilar circulation and the occlusive process truly benefits in cases of suspected acute basilar artery occlusion.