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Table 34-7 Causes of cerebral embolism 1 Cardiac origin a Atrial brillation and other arrhythmias (with rheumatic, atherosclerotic, hypertensive, congenital, or syphilitic heart disease) b Myocardial infarction with mural thrombus c Acute and subacute bacterial endocarditis d Heart disease without arrhythmia or mural thrombus (mitral stenosis, myocarditis, etc) e Complications of cardiac surgery f Valve prostheses g Nonbacterial thrombotic (marantic) endocardial vegetations h Prolapsed mitral valve i Paradoxical embolism with congenital heart disease (eg, patent foramen ovale) j Myxoma 2 Noncardiac origin a Atherosclerosis of aorta and carotid arteries (mural thrombus, atheromatous material) b From sites of dissection and/or bromuscular dysplasia of carotid and vertebrobasilar arteries c Thrombus in pulmonary veins d Fat, tumor, or air e Complications of neck and thoracic surgery f Pelvic and lower extremity venous thrombosis in presence of right-to-left cardiac shunt 3 Undetermined origin

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query in the production system would not be allowed I expand on this discussion of using the BEx Web Analyzer to help increase business user capabilities in the following sections The following illustration shows the final result of a save process in the BEx Query Designer A query developed in the BEx Query Designer has a format available for both the BEx Analyzer frontend (Excel based) and the BEx Web Analyzer (Web based) As you can see, this query has been saved in the Favorites folder, but we also have the option to store the query in a menu role, which is another Folder option Both options make the query available for publishing to the SAP NetWeaver Enterprise Portal once an iView is created

ognized in the last decades to be a more frequent source of embolism than had been appreciated Amarenco and colleagues reported that as many as 38 percent of a group of patients with no discernible cause for embolic stroke had echogenic atherosclerotic plaques in the aortic arch that were greater than 4 mm in thickness, a size thought to be associated on a statistical basis with strokes Disseminated cholesterol emboli are known to occur in the cerebral circulation and may be dispersed in other organs as well; rarely, this is suf ciently severe to cause an encephalopathy and pleocytosis in the spinal uid Paradoxic embolism can occur when an abnormal communication exists between the right and left sides of the heart (particularly a patent foramen ovale, or PFO) or when both ventricles communicate with the aorta; thus embolic material arising in the veins of the lower extremities or pelvis or elsewhere in the systemic venous circulation can bypass the pulmonary circulation and reach the cerebral vessels Pulmonary hypertension (often from previous pulmonary embolism) favors the occurrence of paradoxic embolism, but this may occur with a PFO even in the absence of pulmonary hypertension Of 30 patients in whom a PFO could be demonstrated, 17 had evidence of a right-to-left shunt; brain infarction was associated with positive phlebography of the legs and abnormal pulmonary scintigraphy (Itoh et al) Several studies indicated that the presence of a small atrial septal aneurysm adjacent to the patient foramen increases the likelihood of stroke In the series of Mas and colleagues, patients ages 18 to 55 who had a stroke were followed for 4 years; the risk of second stroke was 2 percent in those with a PFO alone and 15 percent among those with both a PFO and an atrial septal aneurysm (curiously, the risk among those with neither congenital abnormality was 4 percent higher.

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