Patent Foramen Ovale: A Silent Culprit of Cryptogenic Ischemic Stroke

Abstract

Introduction: Patent foramen ovale (PFO) is increasingly recognized as a potential risk factor for cryptogenic ischemic stroke in young patients without conventional vascular risk factors. Methods: We report the case of a 38-year-old man admitted with a superficial right sylvian infarct, in whom comprehensive diagnostic work-up including ECG, carotid Doppler ultrasound, and laboratory testing excluded atrial fibrillation, carotid disease, and thrombophilia. Results: Brain CT confirmed ischemic stroke, and secondary prevention with aspirin and atorvastatin was initiated. Contrast-enhanced transesophageal echocardiography revealed a 3-mm PFO with a significant right-to-left shunt (>20 bubbles during Valsalva maneuver), without atrial septal aneurysm or thrombus. No percutaneous closure was performed, and the patient remained recurrence-free during follow-up under medical management. Conclusion: This case underscores the role of systematic PFO evaluation in cryptogenic stroke, highlights the diagnostic value of imaging in detecting interatrial shunts, and emphasizes the need for individualized management.