Patent foramen ovale (PFO) is a frequent finding in young patients with cryptogenic ischemic stroke (IS). However, little is known about clinical characteristics of PFO-related stroke. We compared acute circumstances and symptomatology between cryptogenic IS with and without PFO. We included patients with cryptogenic IS at age 18-49 enrolled in the multicenter SECRETO study (NCT01934725) who underwent standardized transesophageal echocardiography with Valsalva maneuver and contrast to examine presence of PFO (any degree of shunt). We compared demographics, premonitory symptoms, mode of symptom onset, neurological and cardiac symptoms (chest pain/palpitation), and occurrence of Valsalva inducing activity or heavy physical exertion within 2 hours prior to stroke in patients with and without PFO. Of the 201 patients (mean age 38.6+/-8.0 years; 57.1% men; median admission NIH Stroke Scale [NIHSS] score 2, range 0-20; 21.7% treated with iv-thrombolysis, 6.9% with thrombectomy), 109 (54.2%) had PFO. PFO patients´ symptom onset was more often abrupt than gradual compared to non-PFO patients (79.4% vs. 64.1%; P=0.002), aphasia more common (36.7% vs. 19.6%; P=0.008), but nausea/vomiting (16.5% vs. 29.3%; P=0.030) and headache less frequent (31.2% vs. 46.7%; P=0.024). PFO patients had lower NIHSS score (median 1 vs. 3; P<0.001). In logistic regression adjusted for age and sex, abrupt mode of stroke onset (OR 2.11, 95% CI 1.06-4.21), aphasia (OR 2.89, 95% CI 1.36-6.13) , and lower NIHSS score (OR 0.88, 95% CI 0.80-0.95) were independently associated with PFO-related IS. In conclusion cryptogenic IS patients with PFO had more often sudden symptom onset suggestive of embolic etiology than non-PFO-patients, albeit they had milder symptoms on admission.
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