Seizure and embolic stroke secondary to patent foramen ovale in a migrant girl

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Abstract

Episodes of loss-of-consciousness in school-aged children are not uncommon and include metabolic, cardiovascular, neurological, and psychiatric/psychosocial causes. This case describes a first episode of seizure in an 11-year-old migrant girl. History and language issues contributed to the diagnostic dilemma. Ongoing neurological symptoms prompted transfer to a tertiary care facility where investigation revealed patent foramen ovale (PFO) with likely paradoxical embolus. Prevalence and management of this condition is briefly reviewed in the context of the current presentation.

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Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts.

Terje Hagen, Thomas W D Edwards, D Scholz (1983)

The incidence and size of the patent foramen ovale were studied in 965 autopsy specimens of human hearts, which were from subjects who were evenly distributed by sex and age. Neither incidence nor size of the defect was significantly different between male and female subjects. The overall incidence was 27.3%, but it progressively declined with increasing age from 34.3% during the first three decades of life to 25.4% during the 4th through 8th decades and to 20.2% during the 9th and 10th decades. Among the 263 specimens that exhibited patency in our study, the foramen ovale ranged from 1 to 19 mm in maximal potential diameter (mean, 4.9 mm). In 98% of these cases, the foramen ovale was 1 to 10 mm in diameter. The size tended to increase with increasing age, from a mean of 3.4 mm in the first decade to 5.8 mm in the 10th decade of life.

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Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies.

Emma K Lees, J Overell, I Boné Pina (2000)

To examine the association between patent foramen ovale (PFO) and atrial septal aneurysm (ASA) and stroke. Data from case-control studies that examined the relative frequency of PFO, ASA, or both, in all patients with ischemic stroke, cryptogenic stroke, and known stroke cause as well as control subjects were included. Trials were categorized by age, clinical comparison, and abnormality. Combined OR were calculated using fixed effect (FE) and random effect (RE) methods. Comparing patients with ischemic stroke with control subjects using RE, OR for all ages was 1.83 (95% CI, 1.25 to 2.66) for PFO (15 studies), 2.35 (95% CI, 1.46 to 3.77) for ASA (nine studies), and 4.96 (95% CI, 2.37 to 10.39) for PFO plus ASA (four studies). Homogeneous results were found within the group younger than age 55: using FE, OR was 3.10 (95% CI, 2.29 to 4.21) for PFO, 6.14 (95% CI, 2.47 to 15.22) for ASA, and 15.59 (95% CI, 2.83 to 85.87) for PFO plus ASA. For patients older than age 55, using FE, OR was 1.27 (95% CI, 0.80 to 2.01) for PFO, 3.43 (95% CI, 1.89 to 6.22) for ASA, and 5.09 (95% CI, 1.25 to 20.74) for PFO plus ASA. Comparing cryptogenic stroke with known stroke cause, heterogeneous results were derived from total group examination using RE: OR was 3.16 (95% CI, 2.30 to 4.35) for PFO (22 studies), 3.65 (95% CI, 1.34 to 9.97) for ASA (five studies), and 23.26 (95% CI, 5.24 to 103.20) for PFO plus ASA (two studies). In patients younger than age 55, using FE the OR was 6.00 (95% CI, 3.72 to 9.68) for PFO; only one study examined ASA or PFO plus ASA. In patients aged 55 years or older, three studies produced heterogeneous results for PFO: using RE, OR was 2.26 (95% CI, 0.96 to 5.31); no data were available on ASA prevalence. PFO and ASA are significantly associated with ischemic stroke in patients younger than 55 years. Further studies are needed to establish whether an association exists between PFO and ischemic stroke in those older than 55.

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Patent foramen ovale in cryptogenic stroke: incidental or pathogenic?

Andrew D. Thaler, Adel Alsheikh, Alida Kent (2009)

Patent foramen ovale (PFO) is significantly associated with cryptogenic stroke (CS). However, even in patients with CS, a PFO can be an incidental finding. We sought to estimate the probability that a PFO in a patient with CS is incidental. A systematic search identified 23 case-control studies examining the prevalence of PFO in patients with CS versus control subjects with stroke of known cause. Using simple assumptions and Bayes' theorem, we calculated the probability a PFO is incidental in patients with CS. Random effects meta-analyses estimated the odds ratio (OR) of a PFO in CS versus control subjects in different age populations, with or without atrial septal aneurysms, and were used to summarize across studies the probability that a PFO in CS is incidental. The summary OR (95% CIs) for PFO in CS versus control subjects was 2.9 (CI, 2.1 to 4.0). The corresponding ORs for young and old patients ( or=55 years) were 5.1 (3.3 to 7.8) and 2.0 (>1.0 to 3.7), respectively. The corresponding probabilities that a PFO in patients with CS is incidental were 33% (28% to 39%) in age-inclusive studies, 20% (16% to 25%) in younger patients, and 48% (34% to 66%) in older patients. These probabilities were much lower when an atrial septal aneurysm was present. In patients with otherwise CS, approximately one third of discovered PFOs are likely to be incidental and hence not benefit from closure. This probability is sensitive to patient characteristics such as age and the presence of an atrial septal aneurysm, suggesting the importance of patient selection in therapeutic decision-making.

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Author and article information

Journal

Journal ID (nlm-ta): J Neurosci Rural Pract

Journal ID (iso-abbrev): J Neurosci Rural Pract

Journal ID (publisher-id): JNRP

Title: Journal of Neurosciences in Rural Practice

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0976-3147

ISSN (Electronic): 0976-3155

Publication date (Print): Sep-Dec 2012

Volume: 3

Issue: 3

Pages: 405-407

Affiliations

[1 ] Rural Clinical School – School of Medicine, University of Queensland, Brisbane, Australia

[2 ] Queensland Health, Australia

Author notes

Address for correspondence: Dr. Joseph V Turner, Rural Clinical School – School of Medicine, University of Queensland, c\- Locked Bag 5009, Toowoomba DC, QLD 4350, Australia. E-mail: josephvturner2110@ 123456gmail.com

Article

Publisher ID: JNRP-3-405

DOI: 10.4103/0976-3147.102644

PMC ID: 3505355

PubMed ID: 23189016

SO-VID: a093d681-ed0c-4962-ae10-78540932230b

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Seizure and embolic stroke secondary to patent foramen ovale in a migrant girl

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Most cited references 9

Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts.

Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies.

Patent foramen ovale in cryptogenic stroke: incidental or pathogenic?

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