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Cryptogenic stroke and patent foramen ovale: Clinical clues to paradoxical embolism

Cryptogenic stroke and patent foramen ovale: Clinical clues to paradoxical embolism

Authors :
Ozcan Ozdemir, A.
Tamayo, Arturo
Munoz, Claudio
Dias, Bryan
David Spence, J.
Source :
Journal of the Neurological Sciences. Dec2008, Vol. 275 Issue 1/2, p121-127. 7p.
Publication Year :
2008

Abstract

Abstract: Background: Patent foramen ovale (PFO) is an independent risk factor for cerebral infarction. Since ~25% of the population have a PFO, the simple association of PFO with stroke is not enough to establish the diagnosis of paradoxical embolism. We evaluated possible clinical clues to the diagnosis of paradoxical embolism. Methods: Among patients with cryptogenic ischemic stroke (CS) who were investigated for a right-to-left shunt (RLS), we compared clinical, coagulation and biochemical parameters in patients with PFO versus without PFO. Results: Among 1689 new patients referred for TIA/non-disabling stroke between 2001 and 2007, 175 with cryptogenic stroke (CS) were investigated for RLS by transcranial Doppler (TCD) bubble studies; 89 (5.5%) with positive TCD had a PFO confirmed by TEE. In multivariate logistic regression, a history of DVT or pulmonary embolism (OR, 4.39; 95% CI, 1.23–15.69; p =0.023), prolonged travel (OR, 8.77; 95% CI, 1.775–43.3; p =0.008) , migraine (OR, 2.30: 95% CI, 1.07–4.92; p =0.031), a Valsalva maneuver preceding the onset of focal neurological symptoms (OR, 3.33; 95% CI, 1.15–9.64; p =0.026) and waking up with stroke/TIA (OR, 4.53, 95% CI, 1.26–16.2; p =0.018) were independently associated with PFO-associated cerebrovascular events. Patients with PFO had higher plasma total homocysteine levels than patients without PFO (8.9±3 versus 7.9±2.6 µmol/L respectively; p =0.021). Conclusions: A history of DVT or pulmonary embolism, migraine, recent prolonged travel, sleep apnea, waking up with TIA or stroke or a Valsalva maneuver preceding the event are clinical clues to the diagnosis of paradoxical embolism among patients with CS. [Copyright &y& Elsevier]

Details

Language :
English
ISSN :
0022510X
Volume :
275
Issue :
1/2
Database :
Academic Search Index
Journal :
Journal of the Neurological Sciences
Publication Type :
Academic Journal
Accession number :
35206292
Full Text :
https://doi.org/10.1016/j.jns.2008.08.018