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Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
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Embolic lesion pattern in stroke patients with patent foramen ovale compared with patients lacking an embolic source

Marek Jauss1, Tiemo Wessels, Susan Trittmacher

  • 1Department of Neurology, University of Giessen, Am Steg 14, D-35385 Giessen, Germany. marek.jauss@neuro.med.uni-giessen.de

Stroke
|July 11, 2006
PubMed
Abstract

Insights

The pattern of multiple acute ischemic lesions on diffusion-weighted MRI (DWI-MRI) is common in both cryptogenic stroke and patent foramen ovale (PFO) cases. This finding suggests that distinguishing between these stroke types based solely on lesion patterns is not possible.

Area of Science:

  • Neurology
  • Radiology
  • Cardiology

Background:

  • Multiple acute ischemic lesions on diffusion-weighted MRI (DWI-MRI) are typically attributed to embolic events.
  • However, some patients present with multiple lesions without an identifiable embolic source, leading to a cryptogenic stroke classification.
  • Patent foramen ovale (PFO) is a potential, though often uncertain, embolic source in these cases.

Purpose of the Study:

  • To investigate the prevalence of the multiple-lesion pattern on DWI-MRI in patients with cryptogenic stroke compared to those with PFO.
  • To determine if DWI-MRI lesion patterns can differentiate between cryptogenic stroke and stroke associated with PFO.

Main Methods:

  • Screened 650 stroke patients using DWI-MRI.
  • Excluded patients with alternative embolic sources, carotid disease, or incomplete work-ups.
  • Evaluated 106 eligible patients, with 73 showing DWI lesions.

Main Results:

  • No significant difference in the multiple-lesion pattern was observed between cryptogenic stroke patients and PFO patients.
  • This lack of difference was consistent in both the overall group and the subgroup of young stroke patients (<50 years old).
  • Patients with PFO exhibited a higher incidence of multiple lesions specifically within the posterior circulation.

Conclusions:

  • The presence of multiple lesions on DWI-MRI is frequent, even without a clear embolic source identified through extensive investigation.
  • The study concludes that the multiple-lesion pattern on DWI-MRI cannot reliably distinguish between cryptogenic stroke and stroke presumed to be due to paradoxical embolism from a PFO.

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