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Paradoxical embolism is seen in fewer than 2% of all arterial emboli. It occurs most often through a patent foramen ovale (PFO), which is present in up to one-third of patients with strokes of unknown etiology. We report a 69-year-old woman in whom a thrombus traveled from the lower extremity venous system to her right middle cerebral artery through an unsuspected atrial septal defect. Following right...