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[Patent foramen ovale and cerebral infarct in young patients]
X Jeanrenaud1, J Bogousslavsky, M Payot
1Division de cardiologie, Centre hospitalier universitaire vaudois, Lausanne.
Insights
Patent foramen ovale (PFO) is common in young stroke patients. This study found PFO in 50% of patients under 50 with cerebral infarction, especially those with no other stroke cause.
Area of Science:
- Neurology
- Cardiology
- Radiology
Context:
- Cerebral infarction in patients under 50 years old presents diagnostic challenges.
- Identifying the etiology of stroke is crucial for appropriate management and prevention.
- Patent foramen ovale (PFO) is a potential, yet often overlooked, cause of stroke.
Purpose:
- To determine the prevalence of PFO in young adults (<50 years) admitted for cerebral infarction.
- To investigate the association between PFO and stroke in patients lacking other identifiable stroke sources.
- To assess if age (<40 years) influences PFO prevalence in this cohort.
Summary:
- A prospective study identified 16 patients under 50 with cerebral infarction.
- Overall PFO prevalence was 50% (8/16), with 73% (8/11) in those without other identified stroke causes.
- PFO prevalence was higher (83%) in patients under 40 and during coughing, suggesting paradoxical embolism.
Impact:
- The findings highlight a high prevalence of PFO in young ischemic stroke patients without other identified causes.
- This supports the consideration of PFO as a significant etiological factor in paradoxical embolism.
- The study underscores the importance of screening for PFO in specific young stroke populations.
Abstract:
Over a six months' period we prospectively studied the prevalence of patent foramen ovale (PFO) in patients under 50 years of age admitted for cerebral infarction as assessed by cerebral computed tomography. The study recruited 16 patients (9 male, 7 female, mean age 39 +/- 10 years). Before the contrast study, 5 patients had other identifiable sources of stroke after neurologic investigations and 2-D echocardiography with color-Doppler, whereas 11 had no precise origin. The overall prevalence was 50% with 8 PFO demonstrated, 6 during normal breathing and two during a coughing test. All were in the sub-group of 11 patients without a predetermined source of stroke (prevalence 73%) and in 83% of patients aged under 40. In accordance with the literature, we found a high prevalence of PFO in the ischemic cerebral infarction population aged under 50 years and without another possible source of stroke; this prevalence is higher in patients under 40 years old. This observation confirms the suspicion of paradoxical embolism in these cases.