SUPPLEMENTARY RESULTS EXCLUDED STUDIES Of the 53 potential studies identified, 26 studies were excluded from the final analysis because they did not meet the inclusion criteria. 3 studies considered TTE as the gold standard (1-3), 1 considered catheterization as the reference (4), and 1 considered TCD as the gold standard (5). 13 studies were excluded due to incomplete data (6-18). Of the remaining excluded articles, 3 were retrospective (19-21), 1 had an unclear study design (22), 1 had a small sample size of four patients (23), and 3 did not differentiate between a cardiac and pulmonary RLS (24-26). References 1) Di Tullio M, Sacco RL, Massaro A et al. Transcranial Doppler with contrast injection for the detection of patent foramen ovale in stroke patients. Int J Card Imaging 1993;9:1-5 2) Teague SM, Sharma MK. Detection of paradoxical cerebral echo contrast embolization by transcranial Doppler ultrasound. Stroke 1991;22:740-5 3) Itoh T, Matsumoto M, Handa N et al. Paradoxical embolism as a cause of ischemic stroke of uncertain etiology. A transcranial Doppler sonographic study. Stroke 1994;25:771-5 4) Spencer MP, Moehring MA, Jesurum J, Gray WA, Olsen JV, Reisman M. Power m-mode transcranial Doppler for diagnosis of patent foramen ovale and assessing transcatheter closure. J Neuroimaging 2004;14:342-9 5) Martínez-Sánchez P, Medina-Báez J, Lara-Lara M et al. [Low sensitivity of the echocardiograph compared with contrast transcranial Doppler in right-to-left shunt]. Neurologia 2012;27:61-7 6) Arquizan C, Coste J, Touboul PJ, Mas JL. Is patent foramen ovale a family trait? A transcranial Doppler sonographic study. Stroke 2001;32:1563-6 7) Giardini A, Donti A, Formigari R et al. Transcatheter patent foramen ovale closure mitigates aura migraine headaches abolishing spontaneous right-to-left shunting Am Heart J 2006;151:922.e1-5 8) Giardini A, Donti A, Formigari R et al. Spontaneous large right-to-left shunt and migraine headache with aura are risk factors for recurrent stroke in patients with a patent foramen ovale. Int J Cardiol 2007;120:357-62 9) Van H, Poommipanit P, Shalaby M, Gevorgyan R, Tseng CH, Tobis J. Sensitivity of transcranial Doppler versus intracardiac echocardiography in the detection of right-toleft shunt. JACC Cardiovasc Imaging 2010;3:343-8 10) Walpoth NB, Habermacher K, Moarof I et al. Device-less patent foramen ovale closure by radiofrequency thermal energy. Swiss Med Wkly 2008;138:108-13 11) Zanette EM, Mancini G, De Castro S, Solaro M, Cartoni D, Chiarotti F. Patent foramen ovale and transcranial Doppler. Comparison of different procedures. Stroke 1996;27:2251-5 12) Uzuner N, Horner S, Pichler G, Svetina D, Niederkorn K. Right-to-left shunt assessed by contrast transcranial Doppler sonography: new insights. J Ultrasound Med 2004;23:1475-82 13) Shariat A, Yaghoubi E, Nemati R, Aghasadeghi K, Borhani Haghighi A. Comparison of agitated saline mixed with blood to agitated saline alone in detecting right-to-left shunt during contrast- transcranial Doppler sonography examination. Acta Neurol Taiwan 2011;20:182-7 14) Schwarze JJ, Sander D, Kukla C, Wittich I, Babikian VL, Klingelhöfer J. Methodological parameters influence the detection of right-to-left shunts by contrast transcranial Doppler ultrasonography. Stroke 1999;30:1234-9 15) Kobayashi K, Iguchi Y, Kimura K et al. Contrast transcranial Doppler can diagnose large patent foramen ovale. Cerebrovasc Dis 2009;27:230-4 16) Honek T, Veselka J, Tomek A et al. [Paradoxical embolization and patent foramen ovale in scuba divers: screening possibilities]. Vnitr Lek 2007;53:143-6 17) Nedeltchev K, Mattle HP. Contrast-enhanced transcranial Doppler ultrasound for diagnosis of patent foramen ovale. Front Neurol Neurosci 2006;21:206-15 18) Droste DW, Silling K, Stypmann J et al. Contrast transcranial doppler ultrasound in the detection of right-to-left shunts: time window and threshold in microbubble numbers. Stroke 2000;31:1640-5 19) Telman G, Yalonetsky S, Kouperberg E, Sprecher E, Lorber A, Yarnitsky D. Size of PFO and amount of microembolic signals in patients with ischaemic stroke or TIA. Eur J Neurol 2008;15:969-72 20) Telman G, Kouperberg E, Sprecher E, Yarnitsky D. Countable and non-countable microembolic signals by TCD in first-ever stroke or TIA patients with PFO. J Neurol Sci 2008;268:83-6 21) Lange MC, Zétola VF, de Souza AM et al. Transcranial Doppler for patent foramen ovale screening: is there a good correlation with transesophageal echocardiography? Arq Neuropsiquiatr 2008;66:785-9 22) Di Tullio M, Sacco RL, Venketasubramanian N, Sherman D, Mohr JP, Homma S. Comparison of diagnostic techniques for the detection of a patent foramen ovale in stroke patients. Stroke 1993;24:1020-4 23) Chimowitz MI, Nemec JJ, Marwick TH, Lorig RJ, Furlan AJ, Salcedo EE. Transcranial Doppler ultrasound identifies patients with right-to-left cardiac or pulmonary shunts. Neurology 1991;41:1902-4 24) Lao AY, Sharma VK, Tsivgoulis G, Frey et al. Detection of right-to-left shunts: comparison between the International Consensus and Spencer Logarithmic Scale criteria. J Neuroimaging 2008;18:402-6 25) Lao AY, Sharma VK, Tsivgoulis G, Malkoff MD, Alexandrov AV, Frey JL. Effect of body positioning during transcranial Doppler detection of right-to-left shunts. Eur J Neurol 2007;14:1035-9 26) Sirkis V, Fraiture B, Gass S et al. [Detection of cardial and extracardial right-to-left shunts in young stroke patients]. Nervenarzt 2008;79:195-201