[Functional outcome after one year follow-up in cryptogenetic brain infarction and patent foramen ovale].
OBJECTIVE
The presence of patent foramen ovale (PFO) and atrioseptal aneurysm (ASA)has been described as a risk factor in cryptogenetic stroke. Patients with unknown origin stroke and PFO have less severe symptoms compared to the rest of cryptogenetic stroke patients. We evaluated the clinical situation in stroke patients with PFO and describe the factors predictive of a better outcome after a year.


METHODS
1118 patients between 18 and 70 years old were evaluated, and 223 were classified as having cryptogenetic stroke. Our protocol Included transcranial Doppler, a transesophageal echocardiography (TEE) and a cranial RM. We used the NIH Stroke Scale (NIHSS) to evaluate the clinical situation, and the modified Ranking Scale for the functional outcome.


RESULTS
A total of 117 patients had all inclusion criteria. 66 (56.4%) showed a PFO. We observed a younger age, a higher percentage of females (48.4% in PFO vs. 25.5% in no-PFO) and less risk factors in PFO patients, except for migraine (24.6% in PFO vs. 5.9% in no-PFO; p = 0.01). PFO patients had less severe strokes (NIHSS: 3--median--in PFO vs. 5 in no-PFO; p = 0.010) and a lower grade of sequelae (p 0.024). Worse outcome was related to male, initial neurological evaluation (NIHSS) and presence of ASA. After a logistic regression, only the initial clinical situation (NIHSS) and the presence of ASA were associated with sequelae.


CONCLUSIONS
PFO patients showed a less severe stroke and better functional outcome. The initial neurological involvement and the presence of ASA are predictive of the clinical situation after a year.
Santamarina
Esteban
E
Servicio de Neurología, Hospital Vall d'Hebron, Barcelona, Spain. esantama@vhebron.net
Rubiera
Marta
M
Molina
Carlos A
CA
González Alujas
M Teresa
MT
Evangelista
Arturo
A
Muñoz
Verónica
V
Rovira
Alex
A
Quintana
Manuel
M
Alvarez Sabín
José
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000150:complications / Q000000981:diagnostic imaging; D001921:Brain / Q000098:blood supply / Q000473:pathology; D002544:Cerebral Infarction / Q000175:diagnosis / Q000209:etiology*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging; D006346:Heart Septum; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013997:Time Factors