Stroke, Vol 24, 31-34, Copyright © 1993 by American Heart Association
D Ranoux, A Cohen, L Cabanes, P Amarenco, MG Bousser and JL Mas
BACKGROUND AND PURPOSE: A patent foramen ovale has been reported to be
significantly more frequent in young stroke patients than in matched
control subjects, and paradoxical embolism has been suggested as the main
mechanism of stroke in this situation. The present study was designed to
test this hypothesis. METHODS: Sixty-eight consecutive patients under 55
years of age presenting with an ischemic stroke had an extensive workup,
including transesophageal echocardiography with contrast. We compared the
prevalence of criteria for the diagnosis of paradoxical embolism in
patients with and without a patent foramen ovale. RESULTS: A patent foramen
ovale was found in 32 patients (47%). A Valsalva-provoking activity was
present at stroke onset in six patients with a patent foramen ovale and in
eight patients with no patent foramen ovale (chi 2 = 0.1, nonsignificant).
Clinical/radiological features suggestive of an embolic mechanism were not
more frequent in patients with a patent foramen ovale. Clinical evidence of
deep vein thrombosis was present in one patient with a patent foramen ovale
and in none of the others. No occult venous thrombosis was found in a
subgroup of patients with a patent foramen ovale and no definite cause for
stroke who underwent venography (n = 13). CONCLUSIONS: Our results do not
support the hypothesis that paradoxical embolism is the primary mechanism
of stroke in patients with a patent foramen ovale.
ARTICLES
Patent foramen ovale: is stroke due to paradoxical embolism?
Service de Neurologie, Hopital Sainte-Anne, Paris, France.
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