Abstract Details

Title Pulmonary Hypertension and Patent Foramen Ovale: A Rare Risk Factor for Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P12 - Poster Session 12 (5:30 PM-6:30 PM)

Poster/Presentation
Number 6-022

Objective To illustrate the importance of a comprehensive and individualized stroke evaluation in young patients with pulmonary hypertension presenting with ischemic stroke.

Background

Approximately 45% of strokes in the United States are cryptogenic. A common etiology of cryptogenic stroke is a paradoxical embolism through a patent foramen ovale (PFO). Additionally, pulmonary artery hypertension (PAH) is independently associated with 1.5 times higher odds of stroke. It is unclear the compounded risk of stroke in patients with both a PFO and PAH.

Design/Methods Case Report and Literature Review.

Results A 35-year-old woman with history of PAH presented with vertigo, nausea and headache. Her neurological assessment revealed left-sided dysmetria and truncal ataxia. Brain MRI demonstrated a large left superior cerebellar non-hemorrhagic infarct with partial effacement of the fourth ventricle. She was not a candidate for reperfusion therapy. She required external ventricular drainage. Transthoracic echocardiogram (TTE) showed a dilated right ventricle with reduced systolic function but was otherwise unrevealing. Bilateral lower extremity duplex ultrasound showed no evidence of deep vein thrombosis. The patient was seen in our outpatient multidisciplinary cryptogenic stroke clinic, where repeat TTE with agitated saline injection showed evidence of a PFO. Due to severe pulmonary hypertension, PFO closure was contraindicated, due to potential for worsening right heart function. The patient was started on apixaban for secondary stroke prevention without recurrence of embolic events.

Conclusions

This unique case report highlights the importance of PFO screening in patients with PAH. Patients with PAH have an increased incidence of stroke, the mechanisms of which are not well understood. In this case, PFO was identified in a patient with severe PAH in our outpatient clinic. Right-to-left shunting in this setting may increase risk of paradoxical embolism. A multidisciplinary approach to cryptogenic stroke patients may facilitate identification of rare mechanisms of stroke as well as improve and personalize secondary stroke prevention.

Authors/Disclosures
Jacob Arkin PRESENTER	Mr. Arkin has nothing to disclose.
Ryna Then, MD (Jefferson Einstein Hospital)	Dr. Then has nothing to disclose.
	No disclosure on file

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