Correlation of Patent Foramen Ovale and Stroke: A Case Report

Introduction: Patent foramen ovale has recently been included as one of the possible causes of stroke. Therefore, for its investigation, transthoracic echocardiography is indicated for propaedeutic guidance. Objectives: The study aims to understand the relationship between patent foramen ovale that evolved with cryptogenic stroke. Methods: This is a case report, authorized by the patient for publication, respecting ethical issues. The databases were taken from the PubMed databases. The research period was from August 2023, meeting the inclusion criteria that were articles from the years 2018 to 2023, in Portuguese and English, online texts and in full texts, health descriptors were used. Results: Patient, 49 years old, female, seeks service due to sudden onset diplopia, without associated symptoms. During the investigation period, the patient underwent magnetic resonance imaging, which showed "lesion in the right medulla associated with absence of the posterior inferior cerebral artery, suggesting a subacute ischemic lesion (stroke)." Antiplatelet therapy was initiated and etiological investigation was performed, with complete blood count, biochemistry, lipid profile, autoantibodies, and thromboembolic and imaging profile, all without alterations. A transthoracic echocardiography was performed, which showed the presence of a patent foramen ovale (PFO); surgery for its closure was indicated. Discussion: PFO is a benign finding in the pediatric population in which the septum primum and septum secundum do not fuse, thus leaving a communication between the atria. However, the failure of this structure to close physiologically and anatomically in the first years of life can end up causing diseases. In some cases, cryptogenic stroke, in which the etiology becomes unclear, may have been caused by PFO. Confirmation of the pathophysiology is necessary, however it is believed to occur as a result of paradoxical embolism in which a thrombus passes from the systemic venous circulation to the systemic arterial circulation through a right-to-left shunt, thus being able to reach the central nervous system and thus cause a stroke. The diagnosis was recently included in the study protocols for the etiological search for stroke and consists of brain, aortic and carotid images, cardioembolic screening, screening for thrombophilia, 12-lead ECG, 72-hour Holter, among others, and thus was added to confirm PFO, which is performed by means of transesophageal echocardiography, and classification is performed by associating anatomical conditions of PFO that predispose to systemic embolism. The RoPE study evaluated the clinical characteristics of patients with cryptogenic stroke and PFO and proposed a risk score, stratifying patients by age and presence or absence of vascular risk factors. Conclusion:It is concluded that correct diagnostic investigation for cryptogenic stroke is essential for correct treatment planning and prognosis.