Patent Foramen Ovale and Cryptogenic Strokes in the Stroke in Young Fabry Patients Study

Abstract

T he relevance of a patent foramen ovale (PFO) as a frequent cause of stroke is controversial. [1][2][3][4] Because of its higher prevalence, it is generally considered causative in cryptogenic stroke patients aged <55 years. 5,6 However, the term cryptogenic stroke itself is not well defined and comprises typically also patients with less distinctive diseases like Background and Purpose-A patent foramen ovale (PFO) is disproportionately prevalent in patients with cryptogenic stroke. Without alternative explanations, it is frequently considered to be causative. A detailed stratification of these patients may improve the identification of incidental PFO. Methods-We investigated the PFO prevalence in 3497 transient ischemic attack and ischemic stroke patients aged 18 to 55 years in the prospective multicenter SIFAP1 study (Stroke in Young Fabry Patients 1) using the ASCO classification.Patients without an obvious cause for transient ischemic attack/stroke (ASCO 0) were divided into subgroups with and without vascular risk factors (ASCO 0+ and 0−). In addition, we looked for PFO-related magnetic resonance imaging lesion patterns. Results-PFO was identified in 25% of patients. Twenty percent of patients with a definite or probable cause of transient ischemic attack/stroke (≥1 grade 1 or 2 ASCO criterion; n=1769) had a PFO compared with 29% of cryptogenic stroke patients (ASCO 0 and 3; n=1728; P<0,001); subdivision of cryptogenic strokes revealed a PFO in 24% of 978 ASCO 3 patients (n.s. versus ASCO 1 and 2) and a higher prevalence of 36% in 750 ASCO 0 cases (P<0.001 versus ASCO 3 and versus ASCO 1 and 2). PFO was more commonly observed in ASCO 0− (n=271) than in ASCO 0+ patients (n=479; 48 versus 29%; P<0.001). There was no PFO-associated magnetic resonance imaging lesion pattern. 9 The lack of benefit may at least in part be because of treatment of patients with non-PFOmediated TIA or stroke. Therefore identification of patients with ischemic strokes most probably caused by paradoxical embolism, for example, with scoring systems, such as the Risk of Paradoxical Embolism (RoPE) score, 14-18 is important. The SIFAP1 study (Stroke in Young Fabry Patients) was a prospective, observational study in 5023 stroke patients aged 18 to 55 years in 47 centers and 15 countries in Europe. 19,20 The study screened this cohort for the prevalence of Fabry disease, but also prospectively collected informations on vascular risk factors and stroke subtyping, including data about the presence of a PFO or an interatrial septal aneurysm (ASA). The aims of this substudy were to assess the prevalence of a PFO or ASA in patients aged ≤55 years in SIFAP1 study who had a TIA or ischemic stroke, according to subgroups categorized by the ASCO classification system. We hypothesized that the prevalence of a PFO or ASA would be high, especially, in patients with no other cause for their TIA or stroke based on the detailed ASCO classification system. Furthermore, we evaluated the utility of the RoPE scoring system in identifying patients who were m...

Low Diagnostic Yield of Routine Cerebrospinal Fluid Analysis in Juvenile Stroke

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Predictors of Post-stroke Cognition Among Geriatric Patients: The Role of Demographics, Pre-stroke Cognition, and Trajectories of Depression

“…Accompanied by the natural deterioration of cognitive function due to aging, elder people are more prone to depression and cognitive impairment following stroke. Depression and cognitive impairment affect about 30–50% stroke survivors, respectively (Towfighi et al, 2016 ). Therefore, it is critical and pressing to understand the patterns and underlying mechanisms of cognition in relation to geriatric depression in the context of stroke.…”

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Patent foramen ovale-associated stroke repeatedly misdiagnosed as cerebral small vessel disease: A case report

“…[4] However, the presence of other risk factors cannot be used as evidence to exclude the pathogenesis of PFO. Huber et al [7] demonstrated that after adjusting for age factors, for patients suffering from cryptogenic stroke without vascular risk factors, such as hypertension and diabetes mellitus, the detection rate of PFO was 36%, while the detection rate of PFO in patients with vascular risk factors was 20%. The study speculated that PFO-AS was likely to affect posterior circulation, which might be related to the higher blood flow velocity of posterior circulation than that of anterior circulation during Valsalva action.…”