Case report of a patient with recurrent cryptogenic strokes

Vladimir Beronja; A. Brkic; Dragan Unčanin; Ljiljana Kos; Tamara Kovačević-Preradović

doi:10.5937/siks2501011b

January 1, 2025Srce i krvni sudoviOpen Access

Case report of a patient with recurrent cryptogenic strokes

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Key result

PFO closure fails to prevent recurrent strokes but detecting and anticoagulating AFib resolves symptoms.

Why the study?

Cryptogenic stroke accounts for a significant percentage of all strokes, highlighting the need to understand recurrent cases despite standard interventions.

Key Points

To report the clinical management and diagnostic trajectory of a young patient who experienced recurrent cryptogenic ischemic strokes despite catheter-based patent foramen ovale closure.
Clinical and diagnostic evaluation of a 37-year-old female (N=1) with recurrent ischemic neurological deficits and supraventricular tachycardia.
Diagnostic procedures included transesophageal echocardiography, contrast transcranial monitoring, serial brain magnetic resonance imaging, and electrophysiological testing.
Therapeutic interventions involved catheter-based patent foramen ovale closure using an Occlutech 23/25 device, slow-pathway ablation for atrioventricular nodal reentrant tachycardia, and initiation of oral rivaroxaban (20 mg once daily).
Percutaneous closure of the patent foramen ovale failed to prevent clinical recurrences, with magnetic resonance imaging showing lesion progression from 2 to 6 ischemic changes.
Electrophysiological study recorded several paroxysms of atrial fibrillation lasting several minutes, clarifying the etiology of the embolic events.
Following catheter ablation and the initiation of anticoagulant therapy, the patient remained free of neurological deficits and recurrent tachycardia at the 6-month follow-up.

Structured PICO

P

Population

37-year-old female patient with recurrent cryptogenic strokes, patent foramen ovale (PFO), and paroxysmal supraventricular tachycardia.

I

Intervention

Electrophysiological evaluation and ablation of paroxysmal supraventricular tachycardia leading to detection of atrial fibrillation and initiation of anticoagulant therapy (rivaroxaban 20 mg once daily).

O

Outcome

Recurrence of symptomatic stroke or neurological deficitshard clinical

Prolonged monitoring for atrial fibrillation is crucial in patients with cryptogenic stroke, even after PFO closure, as its detection significantly alters therapeutic strategy and prevents recurrence.

Implication

AF detection may redirect to anticoagulation after PFO closure in recurrent cryptogenic stroke; leaves open need for prospective monitoring trials.

Abstract

Cryptogenic stroke is an ischemic stroke of unknown cause after a comprehensive diagnostic workup and accounts for a significant percentage of all strokes. This paper presents the case of a 37-year-old female patient with recurrent ischemic strokes, in whom a patent foramen ovale (PFO) was diagnosed and subsequently closed via catheter-based intervention. Despite this therapeutic procedure, further recurrences occurred. During electrophysiological evaluation and ablation of paroxysmal supraventricular tachycardia, paroxysms of atrial fibrillation were detected, leading to the initiation of anticoagulant therapy. During follow-up, the patient remained free of symptomatic recurrences. This case highlights the importance of prolonged monitoring for the detection of atrial fibrillation in patients with cryptogenic strokes, which can significantly influence therapeutic strategies and recurrence prevention.

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Cite This Study

Beronja et al. (2025) studied this question. Closure of a patent foramen ovale did not prevent recurrent strokes, but detecting atrial fibrillation led to successful anticoagulant therapy and symptom resolution.

synapsesocial.com/papers/696b25a9d2a12237a9348f1d https://doi.org/10.5937/siks2501011b