Cerebral embolization from an inferior vena cava thrombus in tetralogy of Fallot.

Cerebrovascular accident (CVA) complicating cyanotic congenital heart disease (CCHD) is most frequently attributed to cerebral venous thrombosis, only rarely to in situ cerebral arterial thrombosis. Cerebrovascular accident due to paradoxical embolization from an inferior vena cava (IVC) thrombus in a patient with tetralogy of Fallot (TF) is described. This case is the first antemortem documentation of a venous embolic source that caused paradoxical embolization to the brain in a patient with CCHD, and illustrates the importance of noninvasive screening for a venous source of emboli in these patients.