Şenadim Songül, Bozkurt Dilek, Çabalar Murat, Bajrami Arsida, Yayla Vildan
Clinic of Neurology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.
Noro Psikiyatr Ars. 2016 Mar;53(1):63-66. doi: 10.5152/npa.2015.10034. Epub 2016 Mar 1.
Almost one-third of ischemic strokes has an unknown etiology and are classified as cryptogenic stroke. Paradoxical embolism because of a patent foramen ovale (PFO) is detected in 40%-50% of these patients. Recently, PFO has been reported as a risk factor for patients of all age groups.
In this study, 1080 ischemic stroke patients admitted to our clinic (2011-2013) were retrospectively evaluated. Age, sex, risk factors, complete blood count, vasculitis, biochemical and hypercoagulability tests, magnetic resonance imaging, magnetic resonance angiography, transthoracic echocardiography, transeosophageal echocardiography (TEE) findings, and therapeutic approaches were evaluated.
The age range of the participants (seven male and four female patients) was 20-60 years (mean=43.09±11.13 years). Hemiparesis (n=10), diplopia (n=2), hemianopsia (n=2), and dysarthria (n=2) were the main findings of the neurological examinations. Patient medical history revealed hypertension (n=3), asthma (n=1), deep venous thrombosis (n=1), and smoking (n=4). Diffusion-weighted imaging showed middle cerebral artery (n=8) and posterior cerebral artery (n=3) infarctions. In one case, symptomatic severe carotid stenosis was detected. In eight cases, TEE showed PFO without any other abnormalities, but PFO was associated with atrial septal aneurysm in two cases, and in one case it was associated with ventricular hypokinesia and pulmonary arterial hypertension. Antiplatelet therapy was applied to nine patients and percutaneous PFO closure operation to two patients. In a 2-year follow-up, no recurrent ischemic stroke was recorded.
PFO, especially in terms of the etiology of cryptogenic stroke in young patients, should not be underestimated. We want to emphasize the importance of TEE in identifying potential cardioembolic sources not only in young but also in all ischemic stroke patients with unknown etiology; we also discuss the controversial management options of PFO.
近三分之一的缺血性中风病因不明，被归类为隐源性中风。在这些患者中，40%-50%检测出因卵圆孔未闭（PFO）导致的矛盾栓塞。最近，PFO已被报道为所有年龄组患者的一个危险因素。
本研究对2011年至2013年入住我院的1080例缺血性中风患者进行回顾性评估。评估了年龄、性别、危险因素、全血细胞计数、血管炎、生化及高凝状态检查、磁共振成像、磁共振血管造影、经胸超声心动图、经食管超声心动图（TEE）检查结果及治疗方法。
参与者（7例男性和4例女性患者）年龄范围为20-60岁（平均=43.09±11.13岁）。偏瘫（n=10）、复视（n=2）、偏盲（n=2）和构音障碍（n=2）是神经学检查的主要发现。患者病史显示有高血压（n=3）、哮喘（n=1）、深静脉血栓形成（n=1）和吸烟（n=4）。弥散加权成像显示大脑中动脉梗死（n=8）和大脑后动脉梗死（n=3）。1例患者检测出有症状的严重颈动脉狭窄。8例患者TEE显示PFO且无任何其他异常，但2例患者PFO与房间隔瘤相关，1例患者PFO与心室运动减弱和肺动脉高压相关。9例患者接受抗血小板治疗，2例患者接受经皮PFO封堵手术。在2年的随访中，未记录到复发性缺血性中风。
PFO，尤其是在年轻患者隐源性中风的病因方面，不应被低估。我们想强调TEE不仅在年轻患者，而且在所有病因不明的缺血性中风患者中识别潜在心源性栓子来源的重要性；我们还讨论了PFO存在争议的治疗选择。
