Case history
Case history
A 43-year-old male smoker with no significant past medical history presents with sudden onset of right-sided weakness of his body. He has no previous history of hypertension, diabetes mellitus, or cerebrovascular accident. Physical examination reveals right-sided hemiparesis with expressive dysphasia. An ECG shows normal sinus rhythm. A head computed tomography shows a cerebral infarct in the left middle cerebral artery distribution. Carotid ultrasound does not show any significant obstruction. A transesophageal echo indicates a PFO with a large number of microbubbles crossing into the left atrium after intravenous injection of agitated saline.
Other presentations
A patient with a PFO may present with a migraine headache. Migraine sufferers have a higher incidence of PFO and there have been reports of migraine relief following surgical closure.[2] Platypnea-orthodeoxia syndrome is a rare disorder associated with a PFO. The patient presents with oxygen desaturation and shortness of breath in the upright position with relief of symptoms when recumbent.[3] PFO may also manifest as venous-to-arterial gas embolism and some forms of decompression sickness in underwater divers or astronauts.[4]
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