INNOCENT UNTIL PROVEN GUILTY: PERSISTENT FORAMEN OVALE IN CRYPTOGENICSTROKE – A CLINICAL CASE

Abstract

Persistent foramen ovale (PFO) is the most common anatomic cause of atrial septal defect, occurring in one quarter of the population. It is usually asymptomatic, but may cause paradoxical embolism manifesting such as stroke, myocardial infarction, or peripheral ischemia. When a PFO is found in a patient with cryptogenic stroke, it is not always clear whether the foramen ovale is related to it or an incidental finding. The RoPE score system calculates the probability of a PFO being an etiological factor for the experienced stroke and estimates the risk of its recurrence. The scoring system has implications for assisting clinicians in making secondary prevention decisions. We present a clinical case of a 66-year-old patient admitted to the cardiology clinic with frequent headaches and dizziness, in the background of suboptimal blood pressure control. With a medical history of experienced ischemic stroke (ICS) in the left middle cerebral artery (LBMA). From the performed echocardiographic examination with data on the aneurysm of the interatrial septum, classified as type 4. Additional diagnostic studies were performed, which established an interatrial defect, proving the presence of a Resistant Foramen Ovale (PFO). The discovery of the PFO led to the hypothesis of paradoxical embolism that led to the stroke. To determine the relationship between the two findings, we used the RoPE rating scale. The paper details the algorithm of all diagnostic tests for PFO identification and assessment of the relationship between the PFO and the index cerebral ischemic event. Special attention is given to some key points useful in daily practice that summarize how to better understand the clinical significance of PFO. This clinical case highlights the paramount importance of working in a multidisciplinary team and seeking consultation with a cardiologist to screen for PFO in patients with cryptogenic stroke, especially in young patients without accompanying traditional risk factors for stroke.