We report a case of a 43-year-old woman with brainstem encephalitis in the third trimester of pregnancy. She presented complex visual and auditory hallucinations in the acute disease phase (hearing opera arias and seeing room furniture upside-down). Hallucinations resolved with antiviral treatment.

Patent foramen ovale (PFO) is a congenital heart disease remnant of fetal circulation. The flap of the foramen ovale (septum primum) closes against the atrial septum (septum secundum) and normally fuses within the first two years of life. If the septum secundum covers the oval foramen, but does not seal to the septum primum, then a probable PFO exists that can be "opened" by the Valsalva or other maneuvers that increase right atrial pressure 1,2 . Prevalence of incomplete fusion is approximately 25-27% 1,3 and is associated with atrial septum aneurysm (ASA) in 50-80% patients in a global population 3 . The opening between the left and right atria can introduce venous blood or venous thrombus to the arterial system by crossing into the left heart through a right-to-left shunt (RLS) [1][2][3][4][5] . Studies have demonstrated that RLS emboli and PFO are significantly associated with cryptogenic ischemic stroke, transient ischemic attack (TIA) and migraine with aura in young adults (below 55 years of age) [2][3][4][5] . Prevention against further embolic events by PFO closure is a controversial issue, however the procedure is indicated in some restricted cases [6][7][8][9][10][11][12][13] . The aim of this study was to certify whether or not the PFO method of closure confirmed by transcranial Doppler prevented microemboli after a minimum of 12 months. ABSTRACT Patent foramen ovale (PFO) closure is indicated in some cases to protect patients against embolic events. The aim of this study was to certify that the method of PFO closure to prevent microemboli (MES) is reliable, using contrast enhanced transcranial Doppler (cTCD) as a diagnostic and follow-up tool. Methods: cTCD was performed before and after PFO closure in 20 patients. Results obtained a minimum of 12 months after the procedure were analyzed in this study. Results: After the procedure, 14 patients (82%) showed no microemboli in cTCD at rest, but after provocative Valsalva maneuver (VM) microembolic phenomenon were still detected in 14 (70%): 7 (35%) <10 MES, 3 (15%) 10-20 MES and 4 (20%) had more than 20 MES ("curtain"). Only six of the total patients presented no MES in both resting and VM. Conclusion: These results showed a large percentage of patients with MES detection in a bubble study with transcranial Doppler more than one year after the procedure of PFO closure, showing right-to-left residual shunting. Despite the small number of patients, this study provides important data about this therapeutic decision.Key words: foramen ovale, patent, ultrasonography, Doppler, transcranial, embolism, treatment. RESUMOO fechamento do forame oval patente (FOP) é indicado em alguns casos para prevenir eventos embólicos. O objetivo deste estudo foi certificar que o fechamento do FOP previne contra microembolia usando o Doppler transcraniano contrastado (cTCD) como método diagnóstico e de controle. Métodos: O cTCD foi realizado antes e depois do fechamento do FOP em 20 pacientes. Foram analisados somente os resultados obtidos após 12 meses do procedimento. Resulta...