[Clinical analysis of young and middle-aged stroke patients with patent foramen ovale]

Objective: To investigate the pathogenesis of young and middle-aged stroke patients with patent foramen ovale (PFO) by analyzing clinical characteristics. Methods: Data of 298 consecutive young and middle-aged patients diagnosed as stroke were retrospectively collected from Department of Neurology, Beijing Anzhen Hospital from January 2010 to January 2017.Patients were divided into cryptogenic stroke (CS) group and not-CS group.Risk factors, characteristics of PFO and infarct of imaging were analyzed between two groups. Results: PFO was confirmed in 88 patients among 298 young and middle-aged stroke patients.The prevalence of PFO was 29.6%. Forty-six patients were assigned into CS group and 42 patients were assigned into not-CS group.The ratio of atrial fibrillation and internal carotid artery stenosis in CS group was lower than that in not-CS group (0 vs 12, 4 vs 22, P<0.05). The concentration of homocysteine was lower in CS group than that in not-CS group [(10.4±1.1) mmol/L vs(14.6±2.4) mmol/L, P<0.05]. The difference of migraine and scores of scale of Risk of Paradoxical Embolism (RoPE) in CS group were significantly higher than those in not-CS group [18 vs 4, (6.8±2.5)vs (5.5±1.4), P<0.05]. The prevalence of big PFO, constant right-to-left shunt and atrial septal aneurysm (ASA) in CS group was higher than that in not-CS group (26 vs 6, 36 vs 18, 5 vs 0, P<0.05). Post-circulation location, single cortex infarction and multiple infarctions in multiple vascular areas are indicative of PFO (25 vs 18, 15 vs 7, 20 vs 8, P<0.05). Conclusion: Migraine, high scores of RoPE, big PFO, constant RLS and ASA are indicative of important role of PFO in cryptogenic stroke in young and middle-aged patients.The imaging characteristics of CS with PFO should be emphasized.