High frequency of silent pulmonary embolism in patients with cryptogenic stroke and patent foramen ovale.
OBJECTIVE
Deep vein thrombosis and pulmonary embolism (PE) prove venous embolic activity and enforce the suspicion of paradoxical embolism in patients with stroke with patent foramen ovale. Because it has implications in secondary prevention, we investigated the frequency of silent PE in such a cohort of patients.


METHODS
Patients with cryptogenic stroke or transient ischemic attack and patent foramen ovale who underwent a ventilation perfusion scintigraphy were identified from a stroke registry. Blinded from clinical data, ventilation perfusion scintigraphy scans were re-evaluated independently by 2 experts. Patients showing at least a subsegmental defect were considered as having silent PE. Factors potentially associated with PE were analyzed.


RESULTS
The evaluation included 151 patients. Median age was 55.2 years and 59.9% were male. In 56 (37%) patients, silent PE was found; a deep vein thrombosis was evident in 11 (7%) patients. Atrial septal aneurysm was identified in 39 patients and hypermobile atrial septum in 37 patients. Atrial septal aneurysm and hypermobile atrial septum were independently associated with PE. In females, intake of oral contraceptives showed certain association with PE (6 of 25 versus 3 of 40; P=0.07).


CONCLUSIONS
Silent PE frequently occurs in patients with cryptogenic stroke and patent foramen ovale, particularly when atrial septal aneurysm or hypermobile atrial septum are present.
Department of Neurology, Justus Liebig University Giessen, Giessen, Germany.
Christian
C
Tanislav
Maximilian
M
Puille
Wolfgang
W
Pabst
Frank
F
Reichenberger
Mathias
M
Grebe
Max
M
Nedelmann
Manfred
M
Kaps
Jens
J
Allendörfer
D015331:Cohort Studies; D003937:Diagnosis, Differential; D019320:Embolism, Paradoxical / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012042:Registries; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications* / Q000175:diagnosis