Patent Foramen Ovale: A Silent Culprit of Cryptogenic Ischemic Stroke
AISSAM ELMEJJATI *
Department of Cardiology, Military Hospital Mohammed V, Rabat, Morocco.
YASSINE LEMZABI
Department of Cardiology, Military Hospital Mohammed V, Rabat, Morocco.
PR ILYASS ASFALOU
Department of Cardiology, Military Hospital Mohammed V, Rabat, Morocco.
PR ATIF BENYASS
Department of Cardiology, Military Hospital Mohammed V, Rabat, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Patent foramen ovale (PFO) is increasingly recognized as a potential risk factor for cryptogenic ischemic stroke in young patients without conventional vascular risk factors.
Methods: We report the case of a 38-year-old man admitted with a superficial right sylvian infarct, in whom comprehensive diagnostic work-up including ECG, carotid Doppler ultrasound, and laboratory testing excluded atrial fibrillation, carotid disease, and thrombophilia.
Results: Brain CT confirmed ischemic stroke, and secondary prevention with aspirin and atorvastatin was initiated. Contrast-enhanced transesophageal echocardiography revealed a 3-mm PFO with a significant right-to-left shunt (>20 bubbles during Valsalva maneuver), without atrial septal aneurysm or thrombus. No percutaneous closure was performed, and the patient remained recurrence-free during follow-up under medical management.
Conclusion: This case underscores the role of systematic PFO evaluation in cryptogenic stroke, highlights the diagnostic value of imaging in detecting interatrial shunts, and emphasizes the need for individualized management.
Keywords: Cryptogenic stroke, Patent foramen ovale, Paradoxical embolism, Transesophageal echocardiography, Secondary prevention