Neuroimaging Characteristics Of Cryptogenic Stroke With And Without Patent Foramen Ovale

ObjectiveIn order to examine specific radiological findings in patients with PFO-related strokes and indicate a likely PFO-related etiology,we compared the imaging findings of patients with PFO and cryptogenic stroke and of those with cryptogenic stroke but without PFO.MethodsWe retrospectively reviewed patients diagnosed with cryptogenic stroke(acute ischemic stroke or transient ischemic attack(TIA))within 2 weeks of the onset of symptoms in the department of people's hospital of Zhengzhou university from January 2013 to April 2016 and all of them underwent contrast transthoracic echocardiography(cTEE)or transesophageal echocardiography(TEE).A total of 70 patients were selected and divided into two groups according to if the patient had a PFO or not.As a result,there were 40 cases with cryptogenic stroke and PFO(+)and 30 cases with cryptogenic stroke and PFO(-).We systematically recorded the following clinical data: age;sex;risk factors for stroke such as hypertension,diabetes mellitus,hyperlipidemia,cardiac disease,cigarette smoking,and alcohol consumption;history of migraine;stroke severity assessed by using the National Institute of Health Stroke Scale(NIHSS)at admission.We also analyzed the lesion patterns on diffusion-weighted imaging(number,location and size),pertinent vascular territory,occlusion of the corresponding arteries and history of stroke and compared the datas between the two groups.ResultsOf the 70 patients,19 female cases and 51 male cases had an average age of 36.54±12.14.There was no statistically significant difference between the two groups about general clinical datas.Migraine was more common in patients with PFO-related stroke than in PFO(-)CS patients,with a statistically significant difference(15% vs 0%,P = 0.027).The lesion pattern of a PFO-stroke was more frequently observed as multiple lesions in multicirculatory(25% vs.6.7%,P = 0.044),and infarcts of PFO-stroke were more likely to be distributed in the vertebrobasilar artery territory(40% vs.16.7%,P = 0.035),especially in the posterior cerebral artery territory(44.5% vs.10%,P = 0.016).By contrast,cryptogenic stroke without PFO was more frequently observed as confluent lesion(>15 mm)with additional lesions in single circulatory territory(30% vs.7.5%,P = 0.013),and were more likely to be distributed in left internal carotid circulation(46.7% vs.20.0%,P = 0.017).Conclusion1.Multiple lesions in multicirculatory and the posterior predominance suggest that paradoxical embolism may be the mechanism of PFO-stroke.2.It is indicate that the etiology of cryptogenic stroke patients with radiological features of confluent lesion(>15 mm)with additional lesions in single circulatory territory may be excluded PFO.3.The association between migraine and PFO(+)CS suggest that it is necessary to screen PFO in patients with migraine and CS.