Systemic embolic events associated with persistent foramen ovale: A case report

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Introduction. Embolization into the systemic circulation through the persistent foramen ovale is known as paradoxical embolization. Coexistence of paradoxical embolism with pulmonary thromboembolism is rare and it requires detailed examination. The objective of this study was to present an unusual case of stroke that was complicated by the occurrence of pulmonary thromboembolism, with thrombosis of the superior mesenteric artery, and arterial infarction of numerous visceral organs, a few days after its onset. Case Report. A 60-year-old female patient was admitted to the Emergency Center with clinical symptoms of acute ischemic stroke, with sudden left hemiparesis. Computed tomography showed a fresh ischemia in the basin of the right anterior cerebral artery. The initial clinical course was favorable, with gradual regression of neurological symptoms. On the seventh day of hospitalization, the patient presented with a sudden worsening of symptoms. Computed tomography confirmed multiple infarctions of the liver, spleen and both kidneys, partial thrombosis of the superior mesenteric artery, as well as thrombosis of both pulmonary arteries and two fresh ischemic zones, namely right temporal and parieto-occipital, cortico- subcortical. A persistent foramen ovale was found by transesophageal echocardiography, which also confirmed the existence of an atrial septal aneurysm. In the further course, there was an improvement of symtoms. The patient was referred for further rehabilitation therapy. A surgical closure of persistent foramen ovale was indicated. Conclusion. Paradoxical embolism remains a pathology rarely mentioned by clinicians, although it can affect the functional and vital status and prognosis of the patient. Good cardiac evaluation and detection of persistent foramen ovale in every patient with embolic ischemia is of great importance.

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