Menstrual cycle dependent right-to-left shunting: a single-blinded transcranial Doppler sonography study.

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Menstrual cycle dependent right-to-left shunting: a single-blinded transcranial Doppler sonography study.

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Title: Menstrual cycle dependent right-to-left shunting: a single-blinded transcranial Doppler sonography study.
Author: Klien, S; Spiegel, M; Engelhardt, K; Schmidauer, C; Ulmer, H; Diepers, M; Schmutzhard, E; Mutzbauer, TS
Abstract: BACKGROUND AND PURPOSE: Menstruation has been described as risk factor for neurological decompression sickness in divers. In considering this for paradoxical gas embolism, we hypothesized that there may be a link between cycle-dependent hormonal changes and the manifestation of a right-to-left shunt (RLS). METHODS: 40 women with a regular cycle of 28 days underwent transcranial Doppler sonography examinations (TCD) on day 1 and on day 15 of the menstrual cycle. Cerebral high intensity transient signs (HITS) proved a RLS. RESULTS: We found a 25% RLS incidence consistent with the literature. In 7 of 10 shunt-positive women it was detected mainly or exclusively on day 15. This difference in PFO detection rate is statistically significant (p = 0.031), indicating more RLS during the peri-ovulatory period. CONCLUSIONS: Our results do not support menstruation as a risk factor for neurological decompression sickness. The peri-ovulatory estrogen peak, which leads to systemic vasodilation, may explain our data. Factors that increase the risk for developing a RLS and thereby paradoxical embolism should be avoided, perhaps including diving during the peri-ovulatory period of the menstrual cycle. Furthermore, contrast PFO testing in fertile females may be most sensitive if conducted mid-cycle. Erratum in: Undersea Hyperb Med. 2006 Jan-Feb;33(1):2 p following table of contents
Description: Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc.
URI: http://archive.rubicon-foundation.org/4057
Date: 2005

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