Acute Ischemic Stroke Due to Paradoxical Embolism from Spontaneous Thrombosis of Large Varicosity – A Case Report

Abstract

Paradoxical embolism can have different kinds of manifestation, with cerebrovascular accidents being the most commonly reported. Several studies have proposed that Patent Foramen Ovale (PFO) is a major risk factor for cryptogenic stroke and the mechanism is assumed to be paradoxical embolism. PFO occurs when the foramen ovale fails to close after the birth and a hole is developed between left and right atria. Many cases of embolism through PFO in patients with Deep Vein Thrombosis (DVT) and in patients who received sclerotherapy for varicose vein have been reported. But we present a rare case of spontaneous thrombosis through PFO and associated stroke in a patient with no other significant risk factor than a varicosity in the lower limb. The PFO can act as the conduit for the clot. Many a times, the causes of the stroke like paradoxical embolism may be overseen. In this case, the Trans Esophageal Echocardiography (TEE) confirmed the presence of PFO and clinical examination and doppler of the lower limb revealed the presence of enlarged varicosities. Hence, thorough workups are needed to confirm the etiology and prevent further strokes, especially in the young patients. Also, to avoid such risk, any atrial septal defects must be repaired as early as possible.