Paradoxical emboli causing ischemic strokes can be a rare presentation of   hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu Syndrome).  A history of epistaxis or haemoptysis and a careful examination of the skin and mucosal surfaces may be important clues. A Trans cranial Doppler bubble study can be used to demonstrate a right to left shut. The conformation of arteriovenous fistulas will require angiogram. It is important to diagnose this rare condition since the management will be different and the usual antiplatelet agents and anticoagulants may cause increase bleeding tendencies in these patients.

Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu Syndrome) presenting with artery of Percehron infarction