Patent foramen ovale size and embolic brain imaging findings among patients with ischemic stroke

Michaela M. Steiner, Marco R. Di Tullio, Tatjana Rundek, Robert Gan, Xun Chen, Chiara Liguori, Michael Brainin, Shunichi Homma, Ralph L Sacco

Research output: Contribution to journalArticle

254 Citations (Scopus)

Abstract

Background and Purpose - Although the cause of stroke among patients with patent foramen ovale (PFO) may be due to paradoxical cerebral embolism (PCE), this mechanism is often difficult to prove. The aim of our study was to evaluate the association between brain imaging findings suggestive of embolism and PFO among ischemic stroke patients. Methods - As part of the Northern Manhattan Stroke Study, 95 patients with first ischemic stroke over age 39 underwent transesophageal echocardiography (TEE) for evaluation of a cardiac source of embolism. The stroke subtype was determined by modified NINDS Stroke Data Bank criteria. Stroke subtype and MRI/CT imaging data were evaluated blind to the presence of a PFO. These findings were compared between two groups: patients with medium to large PFO (≤2 mm) and small (<2 mm) or no PFO. Results - Of the 95 patients who underwent TEE, 31 (33%) had a PFO. The frequency of PFO was significantly greater among patients with cryptogenic infarcts (19 of 42; 45%) compared with patients with determined cause of stroke (12 of 53, 23%; P = 0.02). Medium to large PFOs were found more often among cryptogenic strokes than among infarcts of determined cause (26% versus 6%; P = 0.04). Superficial infarcts occurred more often in the group with larger PFOs than in the group with small or no PFOs (50% versus 21%; P = 0.02). Patients with medium or large PFOs more frequently had occipital and infratentorial strokes (57% versus 27%; P = 0.02). Conclusions - Stroke patients with larger PFOs show more brain imaging features of embolic infarcts than those with small PFOs. Larger PFOs may be more likely to cause paradoxical embolization and may help explain the stroke mechanism among patients with no other definite cause.

Original languageEnglish
Pages (from-to)944-948
Number of pages5
JournalStroke
Volume29
Issue number5
StatePublished - May 1 1998
Externally publishedYes

Fingerprint

Patent Foramen Ovale
Neuroimaging
Stroke
Transesophageal Echocardiography
Embolism
National Institute of Neurological Disorders and Stroke
Paradoxical Embolism
Intracranial Embolism

Keywords

  • Cerebral infarction
  • Echocardiography, transesophageal
  • Foramen ovale, patent

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Steiner, M. M., Di Tullio, M. R., Rundek, T., Gan, R., Chen, X., Liguori, C., ... Sacco, R. L. (1998). Patent foramen ovale size and embolic brain imaging findings among patients with ischemic stroke. Stroke, 29(5), 944-948.

Patent foramen ovale size and embolic brain imaging findings among patients with ischemic stroke. / Steiner, Michaela M.; Di Tullio, Marco R.; Rundek, Tatjana; Gan, Robert; Chen, Xun; Liguori, Chiara; Brainin, Michael; Homma, Shunichi; Sacco, Ralph L.

In: Stroke, Vol. 29, No. 5, 01.05.1998, p. 944-948.

Research output: Contribution to journalArticle

Steiner, MM, Di Tullio, MR, Rundek, T, Gan, R, Chen, X, Liguori, C, Brainin, M, Homma, S & Sacco, RL 1998, 'Patent foramen ovale size and embolic brain imaging findings among patients with ischemic stroke', Stroke, vol. 29, no. 5, pp. 944-948.
Steiner MM, Di Tullio MR, Rundek T, Gan R, Chen X, Liguori C et al. Patent foramen ovale size and embolic brain imaging findings among patients with ischemic stroke. Stroke. 1998 May 1;29(5):944-948.
Steiner, Michaela M. ; Di Tullio, Marco R. ; Rundek, Tatjana ; Gan, Robert ; Chen, Xun ; Liguori, Chiara ; Brainin, Michael ; Homma, Shunichi ; Sacco, Ralph L. / Patent foramen ovale size and embolic brain imaging findings among patients with ischemic stroke. In: Stroke. 1998 ; Vol. 29, No. 5. pp. 944-948.
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abstract = "Background and Purpose - Although the cause of stroke among patients with patent foramen ovale (PFO) may be due to paradoxical cerebral embolism (PCE), this mechanism is often difficult to prove. The aim of our study was to evaluate the association between brain imaging findings suggestive of embolism and PFO among ischemic stroke patients. Methods - As part of the Northern Manhattan Stroke Study, 95 patients with first ischemic stroke over age 39 underwent transesophageal echocardiography (TEE) for evaluation of a cardiac source of embolism. The stroke subtype was determined by modified NINDS Stroke Data Bank criteria. Stroke subtype and MRI/CT imaging data were evaluated blind to the presence of a PFO. These findings were compared between two groups: patients with medium to large PFO (≤2 mm) and small (<2 mm) or no PFO. Results - Of the 95 patients who underwent TEE, 31 (33{\%}) had a PFO. The frequency of PFO was significantly greater among patients with cryptogenic infarcts (19 of 42; 45{\%}) compared with patients with determined cause of stroke (12 of 53, 23{\%}; P = 0.02). Medium to large PFOs were found more often among cryptogenic strokes than among infarcts of determined cause (26{\%} versus 6{\%}; P = 0.04). Superficial infarcts occurred more often in the group with larger PFOs than in the group with small or no PFOs (50{\%} versus 21{\%}; P = 0.02). Patients with medium or large PFOs more frequently had occipital and infratentorial strokes (57{\%} versus 27{\%}; P = 0.02). Conclusions - Stroke patients with larger PFOs show more brain imaging features of embolic infarcts than those with small PFOs. Larger PFOs may be more likely to cause paradoxical embolization and may help explain the stroke mechanism among patients with no other definite cause.",
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AU - Di Tullio, Marco R.

AU - Rundek, Tatjana

AU - Gan, Robert

AU - Chen, Xun

AU - Liguori, Chiara

AU - Brainin, Michael

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AB - Background and Purpose - Although the cause of stroke among patients with patent foramen ovale (PFO) may be due to paradoxical cerebral embolism (PCE), this mechanism is often difficult to prove. The aim of our study was to evaluate the association between brain imaging findings suggestive of embolism and PFO among ischemic stroke patients. Methods - As part of the Northern Manhattan Stroke Study, 95 patients with first ischemic stroke over age 39 underwent transesophageal echocardiography (TEE) for evaluation of a cardiac source of embolism. The stroke subtype was determined by modified NINDS Stroke Data Bank criteria. Stroke subtype and MRI/CT imaging data were evaluated blind to the presence of a PFO. These findings were compared between two groups: patients with medium to large PFO (≤2 mm) and small (<2 mm) or no PFO. Results - Of the 95 patients who underwent TEE, 31 (33%) had a PFO. The frequency of PFO was significantly greater among patients with cryptogenic infarcts (19 of 42; 45%) compared with patients with determined cause of stroke (12 of 53, 23%; P = 0.02). Medium to large PFOs were found more often among cryptogenic strokes than among infarcts of determined cause (26% versus 6%; P = 0.04). Superficial infarcts occurred more often in the group with larger PFOs than in the group with small or no PFOs (50% versus 21%; P = 0.02). Patients with medium or large PFOs more frequently had occipital and infratentorial strokes (57% versus 27%; P = 0.02). Conclusions - Stroke patients with larger PFOs show more brain imaging features of embolic infarcts than those with small PFOs. Larger PFOs may be more likely to cause paradoxical embolization and may help explain the stroke mechanism among patients with no other definite cause.

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