title: Sex differences in cryptogenic stroke with patent foramen ovale.
abstract: BACKGROUND
  Sex differences in patients with patent foramen ovale (PFO) and cryptogenic stroke have not been systematically analyzed. We aimed to determine sex influences on demographics, vascular risk factors, clinical manifestations, stroke location, and clinical outcome.
  
  
  METHODS
  One thousand two hundred eighty-eight consecutive patients with ischemic stroke or transient ischemic attack (TIA) were admitted to a single stroke center. All patients underwent a complete stroke workup including clinical examination, standard blood tests, cerebral and vascular imaging, transesophageal echocardiography, and 24-hour electrocardiography. In 500 patients, no definite etiology could be established (cryptogenic stroke/TIA). Of them, 167 patients (107 men and 60 women, mean age 52 +/- 13 years) had an PFO.
  
  
  RESULTS
  The prevalence of PFO in patients with cryptogenic stroke or TIA was higher in men than in women (38% vs 28%, P = .014). Stroke severity and the prevalence of risk factors did not differ between the 2 sexes. There was an independent association between male sex and stroke location in the posterior cerebral circulation (OR 3.0, 95% CI 1.4-6.5, P = .006). Men and women did not differ in respect to PFO grade, prevalence of right-to-left shunt at rest, or coexistence of atrial septal aneurysm. Clinical outcome at 3 months was similar in both sexes.
  
  
  CONCLUSIONS
  Patent foramen ovale was more prevalent in men than in women with cryptogenic stroke. There were no sex influences on age, risk factors, echocardiographic characteristics of PFO, or clinical outcome. Male sex was independently associated with stroke in the posterior cerebral circulation.
authors.affiliation: Department of Neurology, University Hospital of Bern, Bern, Switzerland.
authors.forename: Krassen
authors.initials: K
authors.lastname: Nedeltchev
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wiedmer
authors.forename: Markus
authors.initials: M
authors.lastname: Schwerzmann
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Tobias
authors.initials: T
authors.lastname: Haefeli
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold