From the Neurological Institute (M.M.S., T.R., R.G., X.C., R.L.S.) and
the Division of Cardiology, Department of Medicine (M.R. Di T., C.L., S.H.),
Columbia-Presbyterian Medical Center, New York, NY; Division of Biostatistics
(X.C.) and Division of Epidemiology and Gertrude H. Sergievsky Center
(R.L.S.), School of Public Health, Columbia University, New York, NY; and
Center for Postgraduate Studies in Neuroscience, Danube University,
Landesnervenklinik Gugging (M.M.S., M.B.), Gugging, Austria.
Correspondence to Ralph L. Sacco, MS, MD, Neurological Institute, Columbia–Presbyterian Medical Center, 710 West 168th St, New York, NY 10032. E-mail rls1{at}columbia.edu
Background and Purpose—Although the
cause of stroke among patients with patent foramen ovale (PFO) may be
due to paradoxical cerebral embolism (PCE), this mechanism is often
difficult to prove. The aim of our study was to evaluate the
association between brain imaging findings suggestive of embolism and
PFO among ischemic stroke patients.
Methods—As part of the Northern Manhattan Stroke Study, 95
patients with first ischemic stroke over age 39 underwent
transesophageal echocardiography
(TEE) for evaluation of a cardiac source of embolism. The stroke
subtype was determined by modified NINDS Stroke Data Bank criteria.
Stroke subtype and MRI/CT imaging data were evaluated blind to the
presence of a PFO. These findings were compared between two groups:
patients with medium to large PFO (
Results—Of the 95 patients who underwent TEE, 31 (33%) had a
PFO. The frequency of PFO was significantly greater among patients with
cryptogenic infarcts (19 of 42; 45%) compared with patients with
determined cause of stroke (12 of 53, 23%; P=0.02).
Medium to large PFOs were found more often among cryptogenic strokes
than among infarcts of determined cause (26% versus 6%;
P=0.04). Superficial infarcts occurred more often in the
group with larger PFOs than in the group with small or no PFOs (50%
versus 21%; P=0.02). Patients with medium or large PFOs
more frequently had occipital and infratentorial strokes (57% versus
27%; P=0.02).
Conclusions—Stroke patients with larger PFOs show more brain
imaging features of embolic infarcts than those with small PFOs. Larger
PFOs may be more likely to cause paradoxical embolization and may help
explain the stroke mechanism among patients with no other definite
cause.
© 1998 American Heart Association, Inc.
Original Contributions
Patent Foramen Ovale Size and Embolic Brain Imaging Findings Among Patients With Ischemic Stroke
2 mm) and small
(<2 mm) or no PFO.
Key Words: cerebral infarction • echocardiography, transesophageal • foramen ovale, patent
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