Perforated foramen ovale in the course of ischemic stroke

Abstract

Introduction: Ischemic stroke represents the third cause of death and the first cause of disability in Western countries. It is estimated that 30-40% of them are classified as indeterminate, a proportion that reaches up to 50% in the subgroup of young patients. Stroke in a young adult (15-45 years) constitutes 10% of all strokes. It presents peculiarities from a both etiopathogenic, etiological and prognostic point of view; so it requires a specific, exhaustive and individualized approach.
Clinical Case: A 43-year-old male patient with a history of closed congenital interatrial communication, peripheral venous insufficiency and smoker was referred to the "Hermanos Ameijeiras" Hospital with a stroke to define the etiological diagnosis. Physical examination revealed mild dysarthria, right central facial paresis with left hemiparesis. The imaging study of simple tomography (computerized axial tomography) was negative, and the cranial magnetic resonance showed cerebral infarction in the territory of the right middle cerebral artery. A bubble test was performed by transcranial Doppler, showing right-left shunt, and the existence of permeable foramen ovale was verified by ecotransesphagic study. Therapeutic treatment was started with double antiplatelet therapy and a percutaneous closure of the permeable foramen ovale was performed.
Conclusions: The persistence of the permeable foramen ovale was demonstrated in this patient as a cause of cerebral infarction with the realization of the different ultrasonographic techniques available and percutaneous closure of the FOP was performed, to avoid recurrences of cerebral infarction.