Persistent foramen ovale as a cause of cerebral strokes in young individuals - case reports

Abstract

Foramen ovale is a small congenital defect in the level of the interatrial septum of the heart that occurs as a result of the failure of fusion between the septum primum and septum secundum during embryogenesis. It is present in about 25% of the population and is usually clinically insignificant. However, in some cases, it can lead to paradoxical embolism, which may result in an ischemic stroke. Objective: To investigate the association between patients with persistent foramen ovale (PFO) and the occurrence of strokes in young individuals, with a case report. Case Report: A 27-year-old patient presented for a check-up with a history of multiple episodes, especially in the morning, of weakness in the left limbs, particularly the left arm, accompanied by dizziness. These symptoms spontaneously improved, but in the last episode, the symptoms lasted up to 5 hours from the onset. The patient lives in a small area at a higher altitude. The patient was referred for a neurological examination. The neurological examination was unremarkable at the time of the visit, but due to the recurring symptoms, the patient was referred for a magnetic resonance imaging (MRI) scan of the brain, where punctiform hyperintense lesions were detected. The patient was then referred to a cardiologist, where a transthoracic echocardiogram (TTE) revealed a thin septum, leading to a recommendation for transesophageal echocardiography (TEE). TEE showed the presence of a 2mm PFO, after which the decision was made to close it using an Amplatzer PFO Occluder – 25mm in size. Conclusion: Although rare, a transient ischemic attack (TIA) in younger individuals should prompt consideration of the potential existence of PFO. Timely diagnosis and treatment of PFO are crucial for the lives of these patients.