A patient with patent foramen ovale associated ischemic stroke combined with hemorrhagic transformation: A case report.

RATIONALE

Magnetic resonance imaging (MRI) of patients with patent foramen ovale (PFO)-associated stroke often shows scattered, multiple ischemic lesions, mostly located in the cerebral cortex or vertebrobasilar artery. PFO occlusion is recommended for patients with large right-to-left shunt signals (>4 mm), moderate to large right-to-left shunts, and multiple ischemic lesions on imaging examination if an embolic event is suspected.

PATIENT CONCERNS

A 66-year-old male was admitted to the hospital with dizziness and blurred vision for 16 hours. No other symptoms or signs were observed.

DIAGNOSES

The transcranial doppler bubble test showed a rain curtain-like right-to-left shunt in a resting state, and ultrasound contrast indicated a right-to-left shunt at the level of the atria. MRI indicated a patient infarction site in the right temporal lobe and occipital cortex, and hemorrhage within the infarcted lesion.

INTERVENTIONS

Surgery for PFO occlusion was performed on June 8, 2023.Two subcutaneous injections of low-molecular-weight heparin were administered postoperatively for anticoagulant therapy with 12-hour intervals between 2 shots, and aspirin and clopidogrel were administered for antiplatelet therapy.

OUTCOMES

The patient's condition improved significantly after the operation. During the 3-month follow-up, postoperative cardiac ultrasonography showed that the shape and position of the occluders were normal, and no obvious shunt was found at the atrial level after PFO closure. Dizziness and blurred vision in both eyes returned to normal. The patient's condition was stable, with no symptoms of neurological deficits. As a result, clopidogrel was discontinued.

LESSONS

The transcranial doppler bubble test, a key test for clinical screening of PFO-related stroke, is easy to operate, highly sensitive, less costly, and causes less pain. Combined with ultrasound contrast, it can rapidly identify whether a PFO exists.