Hemodynamic Consequences of Patent Foramen Ovale in Submassive Pulmonary Embolism Leading to Paradoxical Stroke

Abstract

Background: Paradoxical embolism through a patent foramen ovale (PFO) is an uncommon but important mechanism of acute ischemic stroke, especially in the context of pulmonary embolism (PE).

Case Report: We describe a patient who presented with a submassive PE and subsequently developed focal neurological deficits, including word-finding difficulty. Echocardiography identified a PFO with right-to-left shunting, correlating with an acute thalamic infarct.

Methods: Diagnostic evaluation included CT pulmonary angiography confirming submassive PE, transthoracic echocardiography with bubble study demonstrating a PFO, and MRI brain with contrast, which confirmed an acute ischemic thalamic stroke.

Results: Imaging established the coexistence of submassive PE and paradoxical embolic stroke through a PFO. The MRI with contrast localized the infarct and excluded alternative etiologies.

Conclusion: This case emphasizes the importance of maintaining a high index of suspicion for paradoxical embolism in patients with PE and PFO who develop new neurological deficits. Early recognition and appropriate diagnostic workup significantly influence management and clinical direction.