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Case Reports
. 2022 Jul 10;14(7):e26722.
doi: 10.7759/cureus.26722. eCollection 2022 Jul.

A Case of Recurrent Embolic Strokes in a Young Female With a Patent Foramen Ovale and Presumed Fibroelastoma

Nardine Abdelsayed  1 , Kevin Parza  1 , Mohamed Faris  1
Affiliations
Case Reports

A Case of Recurrent Embolic Strokes in a Young Female With a Patent Foramen Ovale and Presumed Fibroelastoma

Nardine Abdelsayed et al. Cureus. .

Abstract

Patent foramen ovale (PFO) occurs in about 25% of the population. PFO closure has been shown to decrease the risk of stroke in patients with recurrent strokes as compared to those treated with medical therapy alone, with more benefit in those with larger PFO sizes. Percutaneous PFO closure, although minimally invasive, does carry surgical risks, which must also be taken into account. We present a case of a 31-year-old female presenting with a left middle cerebellar artery (MCA) stroke and persistent deficits who was found to have both a PFO and presumed fibroelastoma on her aortic valve. She was treated with aspirin and apixaban and advised to follow up with cardiothoracic surgery once she recovered from her stroke for ultimate PFO closure and removal of the fibroelastoma. Unfortunately, she presented again less than one month later with recurrent cerebrovascular accidents (CVA) requiring urgent PFO closure. Our case stresses the importance of tools such as the Risk of Paradoxical Embolism (RoPE) score index when determining treatment plans for patients with PFO, and possible confounding factors such as the presence of an aortic valve fibroelastoma.

Keywords: cerebrovascular accident; fibroelastoma; lupus anticoagulant; patent foramen ovale; protein s deficiency; rope index; stroke.

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Conflict of interest statement

This research was supported (in whole or in part) by HCA Healthcare and or an HCA Healthcare-affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.

Figures

Figure 1
Figure 1. MRI Axial T2 FLAIR demonstrating right insular CVA (yellow arrow)
MRI: magnetic resonance imaging; FLAIR: fluid-attenuated inversion recovery; CVA: cerebrovascular accident
Figure 2
Figure 2. TEE showing 7-mm presumed fibroelastoma present on the aortic valve (yellow arrow)
TEE: transesophageal echocardiogram
See this image and copyright information in PMC

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