Presentation Type
Poster Presentation
Category
Professional Experiences
Abstract/Artist Statement
Background: World-wide, stroke is the leading cause of acquired physical disability in adults and is the second leading cause of mortality in middle-to-high income countries, with an overall incidence of ischemic and hemorrhagic stroke at 85-94 per 100,000. About 10-15% of all strokes occur in adults aged 25-49 years, with approximately 85% of all strokes being ischemic.
Patient: A 20-year-old male hockey player presented with facial tingling and balance difficulty. The patient woke up after a nap with a headache and tingling on the left side of his face. First responders noted the patient had left facial droop and difficulty with speech. Given the patient’s age, stroke was felt to be unlikely and suspected complex migraine or early left facial Bell’s palsy.
Intervention or Treatment: Acute right thalamic stroke extending into the right midbrain was found on brain MRI. A paradoxical embolism was found through a patent foramen ovale (PFO) on echocardiogram. He was provided anticoagulant therapy on discharge with follow up laboratory testing ordered. A cardiology referral was made for consideration of PFO closure, as well as a referral for outpatient physical therapy and a follow up visit in the stroke clinic.
Conclusions: Patent foramen ovale is a common congenital intracardiac condition that occurs in 15-35% of healthy adults. It should always be suspected when there is an embolic event with no identifiable source. Closure of PFO has been deemed to be safe and beneficial for those who participate in sports compared to sedentary individuals.
Clinical Bottom Line: Diagnosis of a stroke requires substantial imaging and diagnostic lab work to confirm presence of a PFO. Non-closure of PFO increases risk of future paradoxical embolisms and transient ischemic attacks, however, more research is needed in elite endurance athletes whose cardiac physiology has adapted to meet higher demands in sport.
Mentor Name
Valerie Moody
Right Anterior Thalamic Stroke Via Paradoxical Embolism Through Patent Foramen Ovale (PFO): A Case Report
UC North Ballroom
Background: World-wide, stroke is the leading cause of acquired physical disability in adults and is the second leading cause of mortality in middle-to-high income countries, with an overall incidence of ischemic and hemorrhagic stroke at 85-94 per 100,000. About 10-15% of all strokes occur in adults aged 25-49 years, with approximately 85% of all strokes being ischemic.
Patient: A 20-year-old male hockey player presented with facial tingling and balance difficulty. The patient woke up after a nap with a headache and tingling on the left side of his face. First responders noted the patient had left facial droop and difficulty with speech. Given the patient’s age, stroke was felt to be unlikely and suspected complex migraine or early left facial Bell’s palsy.
Intervention or Treatment: Acute right thalamic stroke extending into the right midbrain was found on brain MRI. A paradoxical embolism was found through a patent foramen ovale (PFO) on echocardiogram. He was provided anticoagulant therapy on discharge with follow up laboratory testing ordered. A cardiology referral was made for consideration of PFO closure, as well as a referral for outpatient physical therapy and a follow up visit in the stroke clinic.
Conclusions: Patent foramen ovale is a common congenital intracardiac condition that occurs in 15-35% of healthy adults. It should always be suspected when there is an embolic event with no identifiable source. Closure of PFO has been deemed to be safe and beneficial for those who participate in sports compared to sedentary individuals.
Clinical Bottom Line: Diagnosis of a stroke requires substantial imaging and diagnostic lab work to confirm presence of a PFO. Non-closure of PFO increases risk of future paradoxical embolisms and transient ischemic attacks, however, more research is needed in elite endurance athletes whose cardiac physiology has adapted to meet higher demands in sport.