Strokes and holes and headaches: are they a package deal?

Abstract

The relation between patent foramen ovale (PFO) and systemic embolisation, especially transient ischaemic attack or stroke, has attracted considerable interest over the past decades 1 Holmes Jr, DR Cohen H Katz WE Reeder GS Patent Foramen Ovale, Systemic Embolization and Closure. Curr Probl Cardiol. 2004; 29: 49-96 Summary Full Text Full Text PDF Scopus (26) Google Scholar because of the increasingly widespread application of diagnostic echocardiography and now transcranial doppler ultrasound. The possibility that a young woman had a clot pass through a PFO and cause a fatal stroke was suggested in 1877. 2 Cohnheim J Thrombose und Embolie: Vorlesung Uber allgemeine. in: Pathologie. 134. Hirschwald, Berlin, Germany1877 Google Scholar In 1881, Zahn reported systemic embolisation through a PFO in a woman with uterine thrombi; 3 Zahn FW Thrombose de plusieurs branches, de la veine cave inferieure avec embolies consecutives das les arteres pulmonair, splenique, renale et iliaque droite. Rev med Suisse Romande. 1881; 1: 227-237 Google Scholar he added “paradoxical embolism” to the medical lexicon. The use of echocardiography, and agitated saline to document right-to-left shunt, has increased the medical community's awareness of the issue. The process of paradoxical embolism has also been captured on images. 4 Fabricius AM Kruger M Hanke M Mohr FW Caught in the act: impending paradoxical embolism. Asian Cardiovasc Thorac Ann. 2002; 10: 342-343 Crossref PubMed Scopus (10) Google Scholar