| Objectives:1. The purpose of this study is to explore the clinical features of young stroke patients with patent foramen ovale.2. Determine the status of patent foramen ovale in young stroke etiology.3. In the clinical work avoid misdiagnosis of patent foramen ovale in young stroke patients.Materials and Methods:Retrospective study young stroke patients, were chosen from August,2014 to December,2015 in Neurology Department of Qi Lu Hospital and select 7 young patients with patent foramen ovale. Collect the clinical data of patients, physical examination and examination of nervous system. We analyzed their clinical features including the inducement, clinical manifestation, imaging characteristics, laboratory examination, treatment and prognosis. We reviewed the related literatures to investigate the causes、 mechanism、 diagnosis and treatment of young stroke patients with PFO.Result:1. General cases:Seven patients had involvement, six male and one female patients; mean age at presentation,35 years; age range,16-45 years.2. The triggers and basic diseases:Seven patients were acute onset. Three patients had no obvious predisposing causes before the occurring of symptoms, three were doing something and one was sleeping. One had the history of hypertension, one had smoking history and one had history of migraine3. The clinical manifestations and NIHSS score:Three patients felt dizzy with nausea and vomiting, five with alalia and five with physical fatigue numbness symptoms. The NIHSS scores successively were 12,5,3,3,3,2,2.4. Auxiliary examinations:TC、TG and HDL were normal and two of them had slightly higher LDL than the standard values. Four cases of HCY were higher, belong to the category of high homocysteine levels. All of them had essentially normal hemoglobin, but were in upper limit. The routine blood, blood sedimentation, coagulation, liver and kidney function, blood biochemical, tumor markers, rheumatism were all normal.Imageological examination:All of them had MRI. The locations of lesions were different including basal ganglia、 medulla oblongata、 cerebellar hemisphere and so on. Most of them had many small infarct focus. They all had transcranial Doppler and the results are all positive, detecting PFO-related right-to-left shunts. Five patients had the transesophageal echocardiography.5. Treatment and prognosis:7 patients were given platelet, promote the circulation and metabolism of brain cells and so on. They all had patent foramen ovale closure, the patients recovered well after surgery.7 patients of the lobbyists are oral drug therapy, followed up for 3 months to six months, neither recurrence of stroke, and no obvious sequelae.Conclusion:1. Young stroke with patent foramen ovale onset form varied, with no difference compared with stroke caused by other reasons2. Combination of patent foramen ovale clinical characteristics of stroke in youth than other reasons caused by stroke is light;3. In patients with craniocerebral MRI slice can be characterized by multiple infarcts, also can show the individual lesions involved unilateral vascular;4. TCD and TEE should be regarded as routine examination for young stroke with undefined reasons;5. Percutaneous closure of patent foramen ovale is more frequently used. It is a safe and effective treatmentSignificance:The incidence of stroke in young patients increased recently and influenced their family and the society. In clinical work, for the cause of young stroke diagnosis, we should take into account the patent foramen ovale, pay attention to the screening to avoid misdiagnosis and misdiagnosis, and get more experience in clinical diagnosis. |
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