Diagnosis and treatment of 2 cases with cryptogenic stroke due to patent foramen ovale in children: A case report

Abstract

Rationale: Arterial ischemic stroke is a general term for necrosis of brain tissue due to insufficient blood supply to the brain from various causes. About 30% of these cases are of unknown origin and are known as cryptogenic strokes (CS). Patient concerns: We report 2 female patients, one 5 years and 5 months old and the other 6 years old. Both children had clinical manifestations of CS, and after ruling out other possible etiologies, we finally suspected that CS was associated with patent foramen ovale (PFO). Diagnoses: Case 1 was diagnosed with PFO, paradoxical embolism, and third-degree atrioventricular block, and case 2 was diagnosed with PFO, paradoxical embolism, and refractory mycoplasma pneumonia. Interventions: Case 1 underwent permanent pacemaker placement at the same time as PFO closure. Case 2 underwent conservative anticoagulation with poor therapeutic results and subsequently underwent PFO closure. Outcomes: Patient 1 underwent PFO closure, which resulted in relief of neurologic symptoms and no recurrence of neurologic symptoms after 10 months of follow-up. In case 2, the child’s neurologic symptoms improved after PFO closure. Lessons: Although most children with PFO do not require targeted interventions, a few cases involving PFO and CS may benefit from closure of the foramen ovale.