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Neither Here nor There: Impending Paradoxical Embolism

      The challenges inherent in the diagnosis and management of a rare condition were clearly illustrated after a 35-year-old man was admitted to the hospital with ominous symptoms. He first detected a problem when he got up to use the bathroom during the previous night and had trouble balancing. This difficulty persisted when he woke up in the morning, and it was now compounded by double vision, left-sided weakness, and left facial droop. When questioned, he also reported new-onset dyspnea on exertion of 3-4 weeks' duration. The patient was morbidly obese and had a history of gout. His current drug therapy consisted of prednisone, allopurinol, and colchicine. He had quit smoking 1 month earlier.
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