Cerebral paradoxical embolism due to persistent formen ovale in adults

Introduction: The risk of paradoxical cerebral embo-lism is an exceptional condition, which may be asso-ciated with a cardiac malformation such as persistent, undiagnosed and uncorrected foramen ovale.

Objective: Presentation of a cerebral embolism case starting from right inferior limb deep venous throm-bosis, under the conditions of a patent foramen ovale that allowed the right / left interatrial embolic passage. Methods: It is presented the case of a 61-year-old fe-male patient, with no significant pathological history, with deep venous thrombosis of the right inferior limb, complicated shortly after, with an embolic stroke in the left sylvian territory, leading to aphasia and right hemi-paresis. Imaging investigations excluded other causes, including the atherosclerotic stroke, but highlighted the persistence of interatrial foramen ovale.

Results: Assessment of cerebral embolism from right inferior limb deep venous thrombosis required com-plex explorations for pathogenic elucidation. A cardi-ac malformation such as persistent foramen ovale has been diagnosed, allowing the embolic passage from the right to the left, as it entered the cerebral territory cau-sing the stroke. Although pulmonary embolism is the major risk under this condition, right/left interatrial communication has led to the existence of a paradoxi-cal cerebral embolism. Surgical correction of persistent foramen ovale using special prosthesis, as well as anti-coagulant treatment were necessary in the therapeutic management.

Conclusions: The presence of an embolic stroke requi-res evaluation of possible residual cardiac malformati-ons. 2. In case of foramen ovale persistence, there may be a risk of paradoxical cerebral embolism, with star-ting point, deep venous thrombosis. 3. Diagnosis and management of a cardiac malformation is necessary, in order to avoid severe complications.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)