scholarly journals Ischemic Stroke in the Young

2021 ◽  
Vol 27 ◽  
pp. 107602962110022
Author(s):  
Samuel A. Berkman ◽  
Shlee S. Song
Keyword(s):  
Ischemic Stroke ◽  
Patent Foramen Ovale ◽  
Anticoagulation Therapy ◽  
Cryptogenic Stroke ◽  
Artery Dissection ◽  
Cerebral Vein ◽  
Antiphospholipid Antibody ◽  
Foramen Ovale ◽  
Cerebral Vein Thrombosis ◽  
Vein Thrombosis

The purpose of this article is to address several challenging questions in the management of young patients (those age 60 and under) who present with ischemic stroke. Do genetic thrombophilic states, strongly associated with venous thrombosis, independently cause arterial events in adults? Should cases of patent foramen ovale be closed with mechanical devices in patients with cryptogenic stroke? What are the optimal treatments for cerebral vein thrombosis, carotid artery dissection, and antiphospholipid syndrome and are DOACs acceptable treatment for these indications? What is the mechanism underlying large vessel stroke in patients with COVID-19? This is a narrative review. We searched PubMed and Embase and American College of physicians Journal club database for English language articles since 2000 looking mainly at randomized clinical trials, Meta analyses, Cochran reviews as well as some research articles viewed to be cutting edge regarding anticoagulation and cerebrovascular disease. Searches were done entering cerebral vein thrombosis, carotid dissection, anticoagulation therapy and stroke, antiphospholipid antibody and stroke, stroke in young adults, cryptogenic stroke and anticoagulation, patent foramen ovale and cryptogenic stroke, COVID-19 and stroke.

Cerebellar infarction in a patient with cerebral vein thrombosis and patent foramen ovale: brain-to-brain embolism?

2012 ◽  
Vol 33 (6) ◽  
pp. 1415-1417 ◽  
Author(s):  
P. La Spina ◽  
R. S. Calabrò ◽  
C. Casella ◽  
R. Savica ◽  
F. Granata ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Cerebral Vein ◽  
Cerebellar Infarction ◽  
Foramen Ovale ◽  
Cerebral Vein Thrombosis ◽  
Vein Thrombosis

Abstract WP362: Over-Utilization of Studies to Detect Deep Venous Thrombosis in Stroke Patients With Patent Foramen Ovale

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sophie Samuel ◽  
Thuy Nguyen ◽  
Sujan T Reddy ◽  
Kaushik N Parsha ◽  
Sean I Savitz
Keyword(s):  
Ischemic Stroke ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Young Group ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Old Patients ◽  
Vein Thrombosis ◽  
Multivariable Regression ◽  
Deep Vein

Introduction: Cryptogenic stroke may result from paradoxical embolism through a patent foramen ovale (PFO). However, the association between deep vein thrombosis (DVT) and cryptogenic stroke has not been proven. The objective of our study is to compare the incidence of DVT in young and old patients who presented with acute ischemic stroke and were found to have a PFO. Method: We conducted a single-centre retrospective study from January 2014-December 2018. Patients over the age of 18 with ischemic stroke and PFO, who underwent magnetic resonance venography (MRV) of the pelvis and venous doppler ultrasonography (VDU) for assessment of DVT were included. Primary endpoint was the incidence of DVT in patients that were age ≤ 60 (young group) compared to those age > 60 (old group). We further analyzed the incidence of DVT in cryptogenic stroke vs determined origin; and based on the Risk of Paradoxical Embolism (ROPE) score. Results: We included 327 patients: 200 were young (Y) and 127 were old (O). Incidence of DVT was similar for patients in Y versus those in O group (7% vs 8%). A significantly higher ROPE score ≥ 6 was seen in the Y group (71% vs 9%; p<0.001). However, there was no difference in the incidence of DVT in patients with high (9%) or low ROPE scores (8%); OR 0.75, 95% CI (0.32-1.76) p=0.517. Among cryptogenic stroke with high ROPE score and young, incidence of DVT was (7% vs 9%) in determined origin; OR 0.74, 95% CI (0.28-1.96) p=0.557. MRV pelvis detected a clot in 5% of all patients. In a multivariable regression analysis; age, gender, and presence of PFO was not associated with the incidence of DVT. Length of stay and mRS at day 7 were the same between Y and O groups. Conclusions: Detection of DVT was not associated with PFO, high ROPE scores or cryptogenic strokes. Our data indicate an over-reliance of testing for DVT, particularly MRV pelvis with contrast, in patients with PFO. Clinical studies are needed to identify other factors predictive of DVT in patients with ischemic stroke and PFO.

Abstract 2922: Patent Foramen Ovale Is A Cause Of Ischemic Stroke In Patients With Antiphospholipid Syndrome

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Yoshiaki Shimada
Keyword(s):  
Ischemic Stroke ◽  
Antiphospholipid Syndrome ◽  
Patent Foramen Ovale ◽  
Multiple Logistic Regression Analysis ◽  
Cryptogenic Stroke ◽  
Control Group ◽  
Atrial Septal Aneurysm ◽  
Foramen Ovale ◽  
Stroke Patients ◽  
Significant Difference

Background: The antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by a combination of arterial and/or venous thrombosis and recurrent fetal loss, and can be an independent risk factor for a first-ever ischemic stroke especially in young female patients. Patent foramen ovale (PFO) has been established as a cause of cryptogenic stroke. Atrial septal aneurysm (ASA) is associated with PFO. Until recently, the precise pathophysiology of APS as causing ischemic stroke has been essentially unknown. In the present study, we investigated the relationship between APS and potential embolic sources including PFO and ASA using transesophageal echocardiography (TEE). Methods: This study was a retrospective case series design. From July 2006 to June 2008, 120 patients with ischemic stroke who admitted to Juntendo University Hospital underwent TEE. In this study period, consecutive ischemic stoke patients diagnosed as APS based on the modified Sapporo criteria were enrolled and classified into APS group. Controls were selected among age- and gender-matched stroke patients without APS who also underwent TEE. We assessed clinical characteristics and presence of embolic sources including PFO and atrial septal aneurysm (ASA) between APS and Control groups. Results: Nine of ischemic stroke patients with APS and 41 controls were included. Primary APS was present in one patient (11.1%) of the APS group, and APS with SLE were found in eight patients (88.9%). There is no significant difference in age, risk factors for ischemic stroke, and MRI findings between two groups. The prevalence of PFO and ASA were significantly higher in APS group compared to Control group (89% vs 41%, P=0.027; 67% vs 20%, P=0.015, respectively). C reactive protein was relatively higher in APS group. Multiple logistic regression analysis showed that PFO (OR: 13.71; 95% CI: 1.01 to 185.62; P=0.049) and ASA (OR: 8.06; 95% CI: 1.17 to 55.59; P=0.034) were independently associated with the APS group. Conclusion: Atrial septal abnormalities including PFO and ASA are strongly associated with APS group, and could be potential embolic sources in ischemic stroke patients with APS.

scholarly journals Cerebral hemorrhagic infarction as the initial manifestation of deep venous thrombosis in a child with patent foramen ovale

2018 ◽  
Vol 2018 (2) ◽  
Author(s):  
Dimitrios Panagopoulos ◽  
Sofia Loukopoulou ◽  
Evagelos Karanasios ◽  
Gerorgia Grigoriadou ◽  
Nikolaos Eleftherakis
Keyword(s):  
Ischemic Stroke ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Patent Foramen Ovale ◽  
Anticoagulation Therapy ◽  
Unknown Etiology ◽  
Foramen Ovale ◽  
Arterial Ischemic Stroke ◽  
Radiological Investigation ◽  
Ultrasound Study

Arterial ischemic stroke (AIS), with an estimated incidence of 1.1–4.3 per 100,000, is an important cause of morbidity and mortality in children and the risk of recurrence is high. We present the case of an 11-year-old child who presented with a symptomatology of acute ischemic stroke of unknown etiology. The radiological investigation did not reveal any underlying brain abnormality that could cause the event. The diagnostic work up included an echocardiogram, which revealed a thrombus in the right atrium, in conjunction with a patent foramen ovale. The patient was initiated immediately on anticoagulation therapy with low molecular weight heparin and warfarin, but two days later she suffered pulmonary emboli, diagnosed with spiral thorax computed tomography (CT) scan. An ultrasound study of the vessels of the lower extremities revealed deep venous thrombosis (DVT), which was considered to be the underlying causative mechanism.

scholarly journals The research of the relationships between patent foramen ovale and ischemic stroke in elderly patients

2020 ◽  
Author(s):  
Xu Chao Sun ◽  
Wenjing Jiang ◽  
Yan Zhao ◽  
Lin Ma ◽  
Yan Lin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Elderly Patients ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Young Patients ◽  
Test Group ◽  
Control Group ◽  
Foramen Ovale ◽  
Stroke Patients ◽  
Shunt Volume

Abstract Background Research indicates that abnormal embolism caused by patent foramen ovale (PFO) may play an important role in cryptogenic stroke (CS). However, most researches has focused on young patients, and whether abnormal embolism caused by PFO also plays an important role in elderly CS is uncertain. The purpose of this study is to analyze the clinical characteristics of elderly patients with PFO, and to explore the correlation between elderly PFO and ischemic stroke.Methods 62 elderly patients diagnosed with ischemic stroke admitted to Qilu Hospital of Shandong University from April 2014 to April 2019 were selected as the Test Group. 62 non-stroke patients in our hospital's physical examination center and outpatient clinic were selected as the Control Group. Collect clinical data of patients for retrospective analysis.Results The incidence of PFO in the Test Group was significantly higher than that in the Control Group, the difference was statistically significant (p < 0.05). The proportion of large and medium shunt patients in the Test Group was significantly higher than that in the Control Group (p < 0.05). The proportion of patients with migraine in the PFO (+) group in the Test Group was significantly higher than the stroke patients in the PFO (-) group (p < 0.05).Conclusions The shunt volume of the PFO is related to ischemic stroke and may be a risk factor for ischemic stroke.

scholarly journals Ischemic stroke and patent foramen ovale: case report

2006 ◽  
Vol 64 (3b) ◽  
pp. 858-861
Author(s):  
Carlos Eduardo Amaral Pereira da Silva ◽  
Thiago Cardoso Vale ◽  
Flávio José Barbosa Leite ◽  
Thais Gomes Casali ◽  
Gustavo de Moraes Ramalho ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Case Report ◽  
Patent Foramen Ovale ◽  
Clinical Presentation ◽  
Cryptogenic Stroke ◽  
Cerebral Embolism ◽  
Foramen Ovale ◽  
Left And Right ◽  
Right Atria

Approximately 40% of ischemic strokes have no clearly definable etiology and are termed cryptogenic strokes. Patent foramen ovale, a small communication between the left and right atria, is considered to be a risk factor for cerebral embolism. In this study, we report the case of a 29-year-old woman with diagnosis of ischemic stroke due to patent foramen ovale who has undergone percutaneous endovascular closure. The aim of this report is to discuss the relevant aspects of the patent foramen ovale and the cryptogenic stroke, its clinical presentation, diagnosis, management and recurrence.

scholarly journals Five Year Follow-Up of Cryptogenic Stroke Patients Following Patent Foramen Ovale Closure

2021 ◽  
Vol 6 (1) ◽  
pp. 2
Author(s):  
Agnete Teivāne ◽  
Kristaps Jurjāns ◽  
Ainārs Rudzītis ◽  
Krista Lazdovska ◽  
Artūrs Balodis ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Residual Shunt ◽  
Amplatzer Occluder ◽  
Cerebrovascular Events ◽  
Ischemic Attack ◽  
Pfo Closure

Background and Objectives: According to guidelines, patent foramen ovale (PFO) closure is recommended for secondary stroke prevention in patients with cryptogenic stroke. Paradoxial embolism from PFO-mediated right to left shunt has been described as the mechanism of stroke in these cases. The aim of the study was to determine whether PFO closure can be associated with improvement of complaints (headaches, fatigue, heart palpitations, dizziness, and visual impairment) and determine its long-term effectiveness on recurrent stroke risk reduction. Materials and Methods: A total of 103 patients were enrolled in a retrospective study and followed-up by phone up to five years after PFO closure. Standardized survey was conducted about their well-being, recurrent cerebrovascular events, and the use of prescribed medication. Patients were also followed up for residual shunts 24 h, 30 days, 1 year, and 2 years after PFO. The pathogenic ischemic stroke subtypes are determined using CCS (Causative Classification System for Ischemic Stroke). Results: Male patients accounted for 43.7% (n = 45). The mean age was—44.4 ± 13 (18–75). The most probable cause for cryptogenic stroke for 53.4% (n = 55) of patients with possible cardio-aortic embolism was PFO. Residual shunts were mostly observed in patients with Amplatzer occluder—87.5% (n = 14). There was correlation between residual shunt and increased risk of transient ischemic attack recurrence (p = 0.067). Five-years after PFO closure recurrent cerebrovascular events were reported in only 5.1% (n = 5) of patients, this difference is statistically relevant (p < 0.001). Out of 51 patients presented with complaints before PFO closure, 25.5% (n = 13) did not present with any complaints after PFO closure. Conclusions: PFO can be considered a possible risk factor for cryptogenic stroke. PFO closure is effective in reducing recurrent cerebrovascular events. Residual shunt after PFO closure increases the risk of transient ischemic attack recurrence. Amplatzer occluder device is associated with a higher risk for residual shunts after PFO closure. PFO closure can be associated with improvement of complaints.

scholarly journals Patent Foramen Ovale: A Fatal Trap

2019 ◽  
Author(s):  
Tahereh Davarpasand ◽  
Reza Mohseni Badalabadi ◽  
Soheil Mansourian ◽  
Zahra Rahnamoun
Keyword(s):  
Patent Foramen Ovale ◽  
Systolic Dysfunction ◽  
Anticoagulation Therapy ◽  
Right Atrial ◽  
Foramen Ovale ◽  
Blood Oxygen Saturation ◽  
Rare Type ◽  
Oxygen Saturation Level ◽  
Vein Thrombosis ◽  
In Transit

A 39-year-old man referred to us with a complaint of dyspnea and palpitation of 3 days’ duration.  The patient was tachycardic but normotensive with a normal blood oxygen saturation level of about 91%. His electrocardiogram showed a sinus rhythm with an incomplete right bundle branch block. There was no known risk factor for vein thrombosis in his past medical history. Transthoracic and then transesophageal echocardiography revealed a large, hypermobile elongated mass (about 10×1 cm) in the right atrium. The mass was in transit through a large patent foramen ovale (Figure 1, Video 1). There was also severe right ventricular dilation with moderate systolic dysfunction on echocardiography, suggestive of pulmonary thromboembolism (PTE). Consequently, multiple-detector computed tomography angiography was performed to determine mortality risk and help the decision-making regarding the duration of anticoagulation therapy. The angiographic procedure revealed massive bilateral PTE (Figure 2). The patient was referred for atriotomy and pulmonary embolectomy on cardiopulmonary bypass (Figure 3). A thrombus in transit is a life-threatening, albeit rare, type of right-heart thrombosis with mortality rates of 80-100% in untreated patients,1 necessitating urgent assessment and treatment. A thrombus in transit can result in catastrophic systemic embolism in a patient with PTE; therefore, taking heed of this issue in the presence of a right atrial mass is of great therapeutic significance. Meticulous imaging modalities in such patients are mandatory to prove the existence of a patent foramen ovale with a view to deciding on an emergent individualized therapeutic management of the patient’s condition.   

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