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Published on: June 11, 2020
Recurrent episodic hypoxaemic respiratory failure following a stroke
Aaron S C Foo1, Zi Kheng Tan, Evelyn Lee
1Department of General Medicine, Tan Tock Seng Hospital, Singapore. aaronfoosongchuan@hotmail.com
BMJ Case Reports
|August 4, 2012
Summary
A patient experienced cryptogenic stroke and unexplained hypoxia due to a patent foramen ovale (PFO). PFO closure resolved these symptoms, highlighting its importance in cryptogenic stroke and hypoxemia.
Area of Science:
- Cardiology
- Neurology
- Pulmonology
Background:
- A 68-year-old man presented with cryptogenic stroke and recurrent hypoxia.
- Initial investigations ruled out common causes like pulmonary embolism and severe lung disease.
Observation:
- Transthoracic echocardiography initially suggested a minor intrapulmonary shunt.
- Recurrent hypoxia episodes necessitated mechanical ventilation.
- Elevated alveolar-arterial gradients pointed to a non-hypoventilatory cause.
Findings:
- Repeat echocardiography, including transesophageal echocardiography, revealed a patent foramen ovale (PFO) with significant right-to-left shunting.
- An aneurysmal interatrial septum was associated with the PFO.
- This finding provided a unified explanation for both the stroke and hypoxemia.
Implications:
- Percutaneous PFO closure successfully resolved the patient's hypoxic episodes.
- This case underscores the significance of PFO in cryptogenic stroke and unexplained hypoxemia.
- Timely diagnosis and intervention for PFO can lead to successful patient recovery.
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