Patent Foramen Ovale and Cryptogenic Stroke in Older Patients

Handke, Michael; Harloff, Andreas; Olschewski, Manfred; Hetzel, Andreas; Geibel, Annette

doi:10.1056/nejmoa071422

Cited by 543 publications

(333 citation statements)

References 31 publications

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“…Depending on the classification system, cryptogenic strokes account for almost 30% of cases and are more common in young patients. Multiple studies have demonstrated an association between PFO and cryptogenic stroke [8,9] . Since the inner ear requires a high-energy metabolism and the IAA is an end artery with little collaterals from the otic capsule, the inner ear is particularly vulnerable to ischemia [10] .…”

Section: Discussionmentioning

confidence: 99%

Cochleovestibular Transient Ischemic Attack as a Manifestation of Patent Foramen Ovale

2017

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Paradoxical embolization is the most commonly proposed mechanism for ischemia in patients with patent foramen ovale (PFO). We hypothesize that these patients can experience a microembolic genesis of cochleovestibular dysfunction, with a peripheral vestibular syndrome and simultaneous cochlear signs. Hence, we report the first case in literature associating PFO and acute transitory audiovestibular loss, which occurred in a male who had had an ischemic mesencephalic stroke several months ago. The patient's history and duration of the current event of less than 24 hours following complete functional recovery without any damage highlight the vascular cause in cochleovestibular dysfunction and support the existence of a clinical entity that could be named "cochleovestibular transient ischemic attack".

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Section: Discussionmentioning

confidence: 99%

Cochleovestibular Transient Ischemic Attack as a Manifestation of Patent Foramen Ovale

2017

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“…PBE is considered a likely cause of stroke in young patients when more common causes are excluded. However, it can be important also in older patients [10] and as an independent factor even when other cerebrovascular risk factors are present [11].…”

Section: Discussionmentioning

confidence: 99%

A case of paradoxical brain embolism presenting as a typical lacunar stroke

Anzola¹,

Casilli²,

Onorato³

2011

Health

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“…The prevalence of patent foramen ovale was significantly higher in the patients with stroke (40 percent) than in the control group (10 percent).Thy concluded that These results suggest that because of the high prevalence of clinically latent venous thrombosis, paradoxical embolism through a patent foramen ovale may be responsible for stroke more often than is usually suspected. Similarly Handke et al (23) stated that there's a strong significant association between cryptogenic stroke and PFO in younger patients .This can be explained by the fact that younger patients are less likely to have conventional ischemic stroke risk factors (hypertension, high cholesterol, diabetes mellitus, smoking) and so the probability that a PFO is the cause of stroke increases. Several postulated mechanisms were described by Berthet et al (24) ; The most famous is "paradoxical embolism", which is the passage of a thrombus from the peripheral venous system to the left cardiac cavities through the PFO which seems to be the most likely mechanism in patients with cryptogenic stroke associated to PFO, other potential mechanisms should also be considered.…”

Section: **Motor Deficitmentioning

confidence: 99%

Transesophageal Echo Study in Patients With Acute Ischemic Stroke

Mansour

Elzaki

El-Sharkawy

et al. 2014

Zagazig University Medical Journal

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Background: Stroke is one of the major causes of death and disability and due to the high mortality and morbidity rates associated with stroke ,it is becoming a major community health problem worldwide. It has been estimated that cardiogenic emboli are a source of transient ischemic attack (TIA) or stroke in 20% to 40% of all cases. Transesophageal echocardiography (TEE) has been proven superior to transthoracic echocardiography (TTE) for the detection of potential sources of cardiac embolism in patients with previous stroke. In particular, the additional value of TEE in the patients above 45 years of age, in whom TEE is still far from routine procedure, was evaluated. In addition, emphasis was placed on therapeutic consequences, ie, the indication for anticoagulation, based on the results of TEE. Aim of the work : The aim of our study is to evaluate the role of TEE (transesophagealecho) to find indications of anticoagulation despite false absence of its benefit by clinical and transthoracicecho (TTE) examination. Patient and methods:The study was conducted in Zagazig university hospitals and included 100 patients diagnosed with ischemic stroke The diagnosis of stroke was made based on clinical data and brain CT. A full TEE was done and the presence of the following potential sources of embolism was specifically examined (a)left atrial spontaneous echo contrast and thrombus , (b)Impaired Left atrial appendage velocity and the presence of LAA (Left atrial appendage )thrombi , (c)Atheroma in the thoracic aorta, (d)Patent foramen ovale and atrial septal aneurysm (e) others, including valvular vegetations and intracardiac masses . Results:Among the different age groups studied , the prevalence of PFO and MVP (mitral valve prolapse) were highest in patients ˂ 45 years old while the prevalence of complex aortic atheroma was highest in patients ˃45 years old .Risk of stroke recurrence was highest in patients with complex aortic atheroma .Among patients with dyslipidemia,prevalance of ischemic stroke was highest in those older than 45 years old and was significantly higher in low HDL (high density lipoprotein ) (˂40 mg/dl ) and high cholesterol (˃200 mg/dl) group.Furthermore, the risk of stroke recurrence was significantly higher in patients with hypercholesterolemia. Conclusion: TEE has proved to be a very useful tool in diagnosing causes of ischemic stroke .The benefit was not only seen in young age (˂45 years old), but also in those in older age groups .

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Patent Foramen Ovale and Cryptogenic Stroke in Older Patients

Abstract: There is an association between the presence of patent foramen ovale and cryptogenic stroke in both older patients and younger patients. These data suggest that paradoxical embolism is a cause of stroke in both age groups.

Cited by 543 publications

References 31 publications

Cochleovestibular Transient Ischemic Attack as a Manifestation of Patent Foramen Ovale

Cochleovestibular Transient Ischemic Attack as a Manifestation of Patent Foramen Ovale

A case of paradoxical brain embolism presenting as a typical lacunar stroke

Transesophageal Echo Study in Patients With Acute Ischemic Stroke

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