Posters
Presentation Type
Poster
Discipline Track
Clinical Science
Abstract Type
Case Report
Abstract
Background: Strokes are a leading cause of long term disability. Around 800,000 people in the USA have a stroke every year. (CDC) 25% of the population have a Patent foramen ovale (PFO). Stroke in the presence of PFO has been described to be found in up to 40% of patients with “embolic stroke of undetermined source”, otherwise known as cryptogenic strokes. Despite the aforementioned prevalence, there is mixed data on PFO management options. Current management guidelines include dual anti-platelet therapy, anticoagulants, and percutaneous transcatheter closure. Some studies suggest that PFO might be an incidental finding in patients with cryptogenic stroke.
We present an adult female patient with no significant past medical or social history, with abrupt right sided neurological stroke-like symptoms.
Case presentation: 46 year-old female with no significant past medical history, was admitted 7 hours after new onset right facial and upper extremity numbness and weakness, including right facial gaze palsy. After excluding hemorrhagic stroke, dual anti-platelet therapy was initiated, as arrival time was out of window for rTPA . On the second day of admission, the patient had mild worsening of symptoms with 1 point increase in the NIH stroke scale (3) (1 - mild to moderate aphasia; 2 - severe dysarthria). MRI reported acute nonhemorragic CVA involving the posterior left side of pons. Cardiac echocardiography after administration of saline revealed right to left Interatrial shunting, suggesting a small PFO.
Conclusion: The benefits of PFO surgical closure to prevent recurrence in young patients without significant medical history are still in debate.
Clinicians should be aware of the association between PFO and recurrent ischemic stroke, especially in patients presenting with atypical stroke symptoms and young age. Most recent guidelines for the prevention of stroke recommend PFO closure in patients with Deep vein thrombosis and high risk recurrence (Recurrence Risk Estimator at 90 days -RRE-90). A few meta-analyses evaluate percutaneous transcatheter closure with better outcomes than medical therapy.
This case was managed with medical therapy, dual antiplatelet agents to reduce the risk of further thrombotic events. In addition, further investigation was recommended to assess the feasibility of percutaneous closure of the PFO to prevent future paradoxical emboli.
Long-term follow-up with regular monitoring of blood pressure, lifestyle modifications, can be crucial in reducing the risk of recurrent ischemic strokes.
Timely evaluation and consideration of potential underlying cardiac abnormalities can aid in formulating an appropriate management plan to prevent further cerebrovascular events in these patients. Further research is warranted to elucidate the optimal management strategies and long-term outcomes in patients with PFO-associated stroke recurrence.
Academic/Professional Position
Resident
Mentor/PI Department
Internal Medicine
Recommended Citation
Othon Martinez, Diana; Malaga-Espinoza, Barbara; Astorga, Nestor Gerardo; Borra, Vamsikalayan; and Mifuji, Roque, "Delayed management of PFO after Stroke presentation in a healthy Hispanic female" (2024). Research Symposium. 13.
https://scholarworks.utrgv.edu/somrs/2023/posters/13
Included in
Delayed management of PFO after Stroke presentation in a healthy Hispanic female
Background: Strokes are a leading cause of long term disability. Around 800,000 people in the USA have a stroke every year. (CDC) 25% of the population have a Patent foramen ovale (PFO). Stroke in the presence of PFO has been described to be found in up to 40% of patients with “embolic stroke of undetermined source”, otherwise known as cryptogenic strokes. Despite the aforementioned prevalence, there is mixed data on PFO management options. Current management guidelines include dual anti-platelet therapy, anticoagulants, and percutaneous transcatheter closure. Some studies suggest that PFO might be an incidental finding in patients with cryptogenic stroke.
We present an adult female patient with no significant past medical or social history, with abrupt right sided neurological stroke-like symptoms.
Case presentation: 46 year-old female with no significant past medical history, was admitted 7 hours after new onset right facial and upper extremity numbness and weakness, including right facial gaze palsy. After excluding hemorrhagic stroke, dual anti-platelet therapy was initiated, as arrival time was out of window for rTPA . On the second day of admission, the patient had mild worsening of symptoms with 1 point increase in the NIH stroke scale (3) (1 - mild to moderate aphasia; 2 - severe dysarthria). MRI reported acute nonhemorragic CVA involving the posterior left side of pons. Cardiac echocardiography after administration of saline revealed right to left Interatrial shunting, suggesting a small PFO.
Conclusion: The benefits of PFO surgical closure to prevent recurrence in young patients without significant medical history are still in debate.
Clinicians should be aware of the association between PFO and recurrent ischemic stroke, especially in patients presenting with atypical stroke symptoms and young age. Most recent guidelines for the prevention of stroke recommend PFO closure in patients with Deep vein thrombosis and high risk recurrence (Recurrence Risk Estimator at 90 days -RRE-90). A few meta-analyses evaluate percutaneous transcatheter closure with better outcomes than medical therapy.
This case was managed with medical therapy, dual antiplatelet agents to reduce the risk of further thrombotic events. In addition, further investigation was recommended to assess the feasibility of percutaneous closure of the PFO to prevent future paradoxical emboli.
Long-term follow-up with regular monitoring of blood pressure, lifestyle modifications, can be crucial in reducing the risk of recurrent ischemic strokes.
Timely evaluation and consideration of potential underlying cardiac abnormalities can aid in formulating an appropriate management plan to prevent further cerebrovascular events in these patients. Further research is warranted to elucidate the optimal management strategies and long-term outcomes in patients with PFO-associated stroke recurrence.