Dilemma in approach to stroke in sickle cell disease patient: A case report

Cerebrovascular accidents in sickle cell disease (SCD) patients carry a high socioeconomic impact and represent the most important cause of morbidity, neurological deficits, and impaired quality of life in SCD young population.Patent foramen ovale (PFO) is prevalent in 25% of the general population and it is associated with ischemic stroke in the young population via paradoxical embolism, yet there are no specific guidelines to address how to manage SCD patients with PFO who suffer a stroke.

Here we present a young SCD patient, aged 24 years, who suffered a stroke in childhood and later was discovered to have a PFO on subsequent echocardiography. The patient has been receiving blood transfusion therapy since 3 years of age.

No treatment was administered to the patient.The intervention that was done was echocardiography with a bubble study to detect PFO.

Recommendations need to be put in place regarding screening for PFO in patients with SCD, in addition to highlighting issues of whether screening needs to be done in patients who have not developed stroke, and if PFO were to be found, what would be the best management approach and how will prognosis be affected.