scholarly journals Association Between Patent Foramen Ovale and Overt Ischemic Stroke in Children With Sickle Cell Disease

2021 ◽  
Vol 12 ◽  
Author(s):  
Najibah A. Galadanci ◽  
Walter Johnson ◽  
April Carson ◽  
Gerhard Hellemann ◽  
Virginia Howard ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Sickle Cell ◽  
Patent Foramen Ovale ◽  
Contrast Echocardiography ◽  
Transcranial Doppler Ultrasound ◽  
Study Cohort ◽  
Dissemination And Implementation ◽  
Clinical Report ◽  
Foramen Ovale ◽  
Environment Study

Ischemic stroke is one of the most devastating complications of sickle cell anemia (SCA). Previous studies have shown that intracardiac shunting including patent foramen ovale (PFO) can be a potential risk factor for stroke in children with SCA. This study investigates the association between PFO and overt ischemic stroke in the DISPLACE (Dissemination and Implementation of Stroke Prevention Looking at the Care Environment) study cohort of 5,247 children with SCA of whom 1,414 had at least one clinical non-contrast transthoracic echocardiogram. Presence of PFO was taken from the clinical report. Further, we assessed the association between PFO and other clinical and hemolytic factors in children with SCA such as history of abnormal sickle stroke screen [elevated Transcranial Doppler ultrasound (TCD) velocity] and patient's baseline hemoglobin. In 642 children for whom all data were available, the adjusted odds ratio (OR) for overt stroke was higher in those with PFO but this was not statistically significant (OR: 1.49, 95% CI: 0.20–11.03, p = 0.6994). With an OR of 0.85, the study suggested less PFOs in those with abnormal TCD, but this was not statistically significant (95% CI: 0.17–4.25, p = 0.8463). Overall, the prevalence of PFO in this large sub study of non-contrast echocardiography amongst children with SCA is much lower than previous smaller studies using bubble contrast echocardiography. Overt stroke was non-statistically more common in children with SCA and PFO, but there was no evidence that PFO was more common in those with abnormal TCD, the most important pediatric sickle stroke screen.

Stroke in Young Military Men With Heterozygous for MTHFR Gene Mutation or Factor V Leiden Gene Mutation Associated With Patent Foramen Ovale: Report of Two Cases and Therapeutic Strategy

2021 ◽  
Author(s):  
Rodrigo Tavares Brisson ◽  
Josevânia Fulgêncio de Lima Arruda ◽  
Liene Duarte Silva ◽  
Dilermando Leal Júnio de Jesus ◽  
Viviane Flumignan Zetola ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Gene Mutation ◽  
Patent Foramen Ovale ◽  
Myocardial Dysfunction ◽  
Factor V Leiden ◽  
Transcranial Doppler Ultrasound ◽  
Mthfr C677t ◽  
Factor V ◽  
Foramen Ovale ◽  
Factor V Leiden Mutation

ABSTRACT We report two cases of Brazilian patients (a 22-year-old male and a 48-year-old male) with ischemic stroke, whose arterial vascular study and echocardiographic investigation did not reveal any steno-occlusive arterial disease or typical cardioembolic finding, such as atrial fibrillation or myocardial dysfunction. A transcranial Doppler ultrasound and a transesophageal echocardiogram showed a patent foramen ovale (PFO), and the laboratory screening for coagulation abnormalities showed heterozygosity for MTHFR C677T and A1298C in one of the patients and heterozygosity for factor V Leiden gene mutations in the other patient. The significance of the association of PFO with Methylenetetrahydrofolate (MTHFR) C677T and A1298C variants or factor V Leiden mutation is discussed as a possible cause of ischemic stroke through paradoxical embolism from a venous source. There is a high prevalence of these two mentioned conditions in the general population, so we discuss two cases in which indication for anticoagulant therapy or percutaneous closure of PFO prevails.

Abstract 3266: Detection Of Patent Foramen Ovale By Transesophageal Echocardiography and Contrast-Enhanced Cardiac Magnetic Resonance In Patients With Cryptogenic Stroke.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Alfonso Sestito ◽  
Pasquale Santangeli ◽  
Priscilla Lamendola ◽  
Fabio Pilato ◽  
Christian Colizzi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Transesophageal Echocardiography ◽  
Patent Foramen Ovale ◽  
Valsalva Maneuver ◽  
Contrast Echocardiography ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Contrast Enhanced

Background. In ≈ 40% of patients with acute ischemic stroke, the cause remains undefined (cryptogenic stroke). Previous studies, using contrast echocardiography, showed a significant prevalence of a patent foramen ovale (PFO) in patients with cryptogenic stroke < 55 years of age, suggesting a causal role through paradoxical embolism. Contrast transesophageal echocardiography (TEE) is considered the gold standard for PFO detection. Recently, however, cardiac magnetic resonance (CMR) was also shown to reliably detect PFO. In this study we compared the accuracy of CMR and TEE in detecting PFO in a group of patients with cryptogenic stroke. Methods and Results . Sixteen patients (age 50 ± 13 years, 9 males) with cryptogenic ischemic stroke underwent contrast-enhanced TEE and contrast CMR for detection of possible PFO. Both imaging studies were performed during Valsalva maneuver. PFO grading results were assessed visually both for TEE and CMR, according to the entity of contrast passage in the left atrium (grade 0 = no PFO; grades 1, 2 and 3 = mild, medium and wide PFO, respectively). Nine patients (56%) were identified to have a PFO by contrast TEE. Contrast-enhanced CMR identified a PFO in only 5 (56%) of these patients. None of the 7 patients without PFO at TEE was shown to have a PFO at CMR. TEE showed a grade 1 PFO in 4 patients, a grade 2 PFO in 3 and a grade 3 PFO in 2 patients. Of these patients, CMR failed to identify PFO in all patients with a grade 1 PFO at TEE and underestimated the degree of the shunt in the other patients. Conclusions. Our data suggest that TEE should be considered the non-invasive diagnostic reference test to detect and characterize PFO in patients with ischemic cryptogenic stroke.

scholarly journals Stroke and presence of patent foramen ovale in sickle cell disease

2021 ◽  
Author(s):  
Constantina Aggeli ◽  
Kali Polytarchou ◽  
Yannis Dimitroglou ◽  
Dimitrios Patsourakos ◽  
Sophia Delicou ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Patent Foramen Ovale ◽  
Foramen Ovale ◽  
Cell Disease

Patent Foramen Ovale and Ischemic Stroke in Patients With Pulmonary Embolism

2019 ◽  
Vol 171 (7) ◽  
pp. 527
Author(s):  
Preetham Kumar ◽  
M. Khalid Mojadidi ◽  
Bernhard Meier ◽  
Jonathan M. Tobis
Keyword(s):  
Pulmonary Embolism ◽  
Ischemic Stroke ◽  
Patent Foramen Ovale ◽  
Foramen Ovale

scholarly journals Recurrent Patent Foramen Ovale-Related Cerebral Infarcts Alternately Causing Bilateral Hand Paresis

2017 ◽  
Vol 9 (2) ◽  
pp. 210-215 ◽  
Author(s):  
Seung-Jae Lee
Keyword(s):  
Ischemic Stroke ◽  
Transesophageal Echocardiography ◽  
Patent Foramen Ovale ◽  
Holter Monitoring ◽  
Precentral Gyrus ◽  
Foramen Ovale ◽  
Rare Presentation ◽  
Laboratory Findings ◽  
Abnormal Finding ◽  
Hand Motor Area

Isolated hand paresis is a rare presentation of stroke, which mostly results from a lesion in the cortical hand motor area, a knob-like area within the precentral gyrus. I report the case of a patient who experienced recurrent ischemic stroke alternately involving bilateral hand knob areas, causing isolated hand paresis. There was no abnormal finding on brain and neck magnetic resonance angiography, transthoracic echocardiography, and 48-h Holter monitoring, and there were no abnormal immunologic and coagulation laboratory findings. The only embolic source was found to be a patent foramen ovale, which was proven on transesophageal echocardiography. The patient underwent percutaneous device closure of patent foramen ovale after alternately repeated paresis of both hands despite antiplatelet treatment. This case suggests that ischemic stroke affecting the cortical knob area, albeit extremely rare, may recur due to a patent foramen ovale, and it necessitates complete investigation, including transesophageal echocardiography, to identify possible embolic sources.

scholarly journals Contrast Echocardiography and Migraine in Divers with Patent Foramen Ovale

2009 ◽  
Vol 36 (6) ◽  
pp. 740-744 ◽  
Author(s):  
Roberto Di Fabio ◽  
Elisabetta Giugni ◽  
Imerio Angeloni ◽  
Nicola Vanacore ◽  
Carlo Casali ◽  
...  
Keyword(s):  
Preliminary Data ◽  
Patent Foramen Ovale ◽  
Contrast Echocardiography ◽  
Paradoxical Embolism ◽  
Medium Size ◽  
Minimal Size ◽  
Foramen Ovale ◽  
Safe Method ◽  
Cerebral Embolization ◽  
Contrast Solution

Background:It has been proposed that the patent foramen ovale (PFO) may be associated with migraine, in particular migraine with aura. However, it is not clear whether paradoxical embolism triggers crises of headache. Cerebral embolization is provoked in subjects with PFO through contrast echocardiography, a safe method to diagnose the presence of foramen ovale pervium.Methods:Twenty-four men practicing diving, an activity characterized by increased prevalence of PFO and migraine, underwent trans-thoracic echocardiography with contrast solution, composed of saline and air mixture and checked for the occurrence of migraine in the following 24 hours.Results:A PFO (five of minimal size, i.e. visible only during Valsalva, one of small and two of medium size) was detected in 8/24 divers (33%). No one reported headache over the 24 hours after the procedure.Discussion:Our preliminary data suggest that cerebral micro-embolism, provoked by contrast echocardiography, does not systematically trigger migraine crises when a minimal-to-medium sized patent foramen ovale is present.

Patent foramen ovale closure or medical therapy for cryptogenic ischemic stroke: an updated meta-analysis of randomized controlled trials

2018 ◽  
Vol 107 (9) ◽  
pp. 745-755 ◽  
Author(s):  
Volker Schulze ◽  
Yingfeng Lin ◽  
Athanasios Karathanos ◽  
Maximilian Brockmeyer ◽  
Tobias Zeus ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Randomized Controlled Trials ◽  
Medical Therapy ◽  
Patent Foramen Ovale ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Foramen Ovale ◽  
Randomized Controlled
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