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53 year old female presents with cryptogenic stroke. TCD of the right MCA was performed with injection of agitated saline. Imaging was performed during release of Valsalva maneuver. 10–20 High-Intensity Transient Signals (HITS) were noted. This is consistent with a moderate right-to-left intracardiac shunt. This patient underwent closure of a patent foramen ovale (PFO).
