Introduction: Patent Foramen Ovale (PFO) is present in 25% of the general population and as high as 50% in the cryptogenic population.  This observed association has been shown to be causative in a sub-set of stroke patients, with demonstrated efficacy of percutaneous methods of closure,  However in rare cases a PFO may be associated with the development of sudden platypnea orthodeoxia (PO).  Here we present a case of a stroke patient whose rehabilitative course was complicated by recurring episodes of respiratory distress (RD) with PO of initially unclear ethology.  Methods:  A 72 year old woman was admitted with a Right MCA territory infarction occurring secondary to an acute right ICA occlusion. Deficits included hemiparesis, extinction, hemifacial weakness, dysarthria and dysphagia.  Her course was complicated by episodes of RD and PO.  The only ethology identified was that of a possible pulmonary embolism vs artefact on contrast enhanced chest CT.  Serial transthoracic-echocardiography (TTE) with  contrast however showed no right to left shunting, and worsening oxygen requirements precluded transesophageal-echocardiographic (TEE) investigation.  TCD was thus performed which verified suspicion of right to left shunting.  The patient was stabilized and underwent TEE to verify the presence of a PFO.
Results: PFO closure resulted in immediate resolution of the patient’s RD and PO.
Conclusion: PFO can present with new onset RD and PO in stroke patients however is amenable to effective treatment. TCD may have a unique diagnostic role in these cases when TTE is negative and TEE contraindicated.

Platypnea Ortho-Deoxia: A Rare Indication for Patent Foramen Ovale Closure in Stroke.