Patent foramen ovale (PFO) closure to prevent recurrent stroke in a patient with a nickel allergy.

The case of a 44-year-old female with multiple embolic cerebellar infarcts associated with a "high risk" patent foramen ovale (PFO) is presented. This article reviews current management of PFO in association with cryptogenic stroke in light of the results of three recent randomized controlled trials and two meta-analyses of observational data. The article will also discuss circumstances which merit consideration for closure despite the negative trial data, and will review our management strategy for closure in this patient with a nickel allergy that precluded the use of the most commonly used PFO closure device.