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Case Reports
. 2025 Oct 31;17(10):e95824.
doi: 10.7759/cureus.95824. eCollection 2025 Oct.

Posterior Circulation Stroke in a Patient With May-Thurner Syndrome and Patent Foramen Ovale: A Case of Paradoxical Embolism

Carlos A Suanes Zubizarreta  1 , Michael Sinnott  1 , Zehra Rizvi  2 , Roberto Sanchez  2 , Ariol Labrada  2
Affiliations
Case Reports

Posterior Circulation Stroke in a Patient With May-Thurner Syndrome and Patent Foramen Ovale: A Case of Paradoxical Embolism

Carlos A Suanes Zubizarreta et al. Cureus. .

Abstract

Posterior circulation strokes can present with a range of subtle or fluctuating symptoms, often delaying diagnosis and complicating treatment decisions. We present the case of a 59-year-old woman with a prior history of transient ischemic attack (TIA), ischemic stroke, and antiphospholipid syndrome who was brought to the emergency department with acute dysarthria, vertigo, tinnitus, and vomiting. Imaging was initially unrevealing, but brain MRI confirmed acute infarcts in the superior vermis and right cerebellar hemisphere. Further workup revealed a patent foramen ovale (PFO) and May-Thurner syndrome (MTS), which were suspected contributors to a paradoxical embolic stroke. She underwent successful PFO closure and stent placement for left iliac vein compression. This case highlights the diagnostic challenge of posterior strokes and underscores the importance of considering underlying embolic and structural contributors in cryptogenic stroke presentations.

Keywords: antiphospholipid antibody syndrome (aps); may-thurner syndrome (mts); mr venography (mrv); paradoxical emboli; patent foramen ovale (pfo); posterior circulation stroke.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Brain MRI axial images (A and D: DWI, B and E: ADC, C and F: T2 FLAIR) showing small foci of diffusion restriction in the right superior vermis. Hyperintense signals are appreciated on the T2 FLAIR and DWI with hypointense signals on ADC, indicative of an acute infarct. Arrows are pointing to the acute infarcts.
ADC: apparent diffusion coefficient, DWI: diffusion-weighted imaging, MRI: magnetic resonance imaging, T2 FLAIR: T2-weighted fluid-attenuated inversion recovery
Figure 2
Figure 2. MRV pelvis indicating 50% compression of the left common iliac vein (red arrow) between the right common iliac artery (white arrow) and lumbar vertebra, immediately proximal to the IVC confluence compatible with May-Thurner syndrome.
IVC: inferior vena cava, MRV: magnetic resonance venography
See this image and copyright information in PMC

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