Massive paradoxical embolism with cerebral symptoms developed at 30 hours after abdominal hysterectomy in a 53-year-old woman. An essential condition for the occurrence of paradoxical embolism is an increased pressure in the lesser circulation; the most frequent cause is massive pulmonary embolism which, however, may take a relatively mild course if there is adequate right to left shunting. The absence of clinical signs of pulmonary embolism does not exclude systemic venous thrombosis as the site or origin of peripheral arterial emboli.
