Could You Be At Risk for a Cryptogenic Stroke?

When a stroke occurs, it’s crucial for physicians to uncover the cause. The immediate concern is to identify what type of stroke is occurring—ischemic or hemorrhagic—so the proper treatment measures are applied.

Because the highest risk factor for stroke is a previous stroke, neurologists need to understand what prompted the initial stroke so they can work to prevent it from recurring. In some cases, the origin is not clear. Strokes of obscure or unknown origin are known as cryptogenic strokes.

It often takes in-depth investigation to untangle a cryptogenic stroke. However, one very common cause is a hole in the heart between the left and right atria known as patent foramen ovale (PFO).

Implications of Patent Foramen Ovale (PFO)

When a fetus is in the womb, it receives oxygenated blood through the umbilical cord. The heart directs this oxygen-rich blood to various parts of the body using a hole or flap between the right and left atriums. This hole is the PFO. When the baby is born, the PFO is supposed to close. But for about one in four people, it remains open.

Some people experience zero issues from their PFO and go on to live full, healthy lives. However, problems can occur when clots develop and travel through the body, such as with deep vein thrombosis (DVT). Typically, when DVTs dislodge from the leg, they travel to the right side of the heart, then to the lungs where they cause a pulmonary embolism.

In individuals with PFO, the clot is not redirected to the lungs. Instead, it goes straight to the left side of the heart and can travel to the rest of the body—including the brain.

A primary underlying risk factor for clot formation is antiphospholipid syndrome. This condition occurs when the immune system mistakenly creates antibodies that attack bodily tissues. The antibodies can then cause blood clots to form in arteries and veins.

Other risk factors include pre-existing heart issues (e.g., atrial fibrillation), smoking, and a family history of blood clots. Certain medications, like oral contraceptives and hormone therapy drugs, can also contribute to blood clot risk. It’s imperative for women to have all the information they need to make informed decisions when prescribed such medications.

Testing for PFO

Could you have a PFO and not realize it? There are different tests that can identify PFO, such as a specialized ultrasound of the heart known as an echocardiogram. However, these scans don’t always detect the PFO. A more definitive test is the bubble study.

In this test, a saline solution is shaken up to the point of forming tiny bubbles and then is injected into a vein. The doctor then watches where those bubbles travel using an echocardiogram. If no PFO exists and the heart is working properly, the bubbles will travel through the right atrium, to the right ventricle, then out the pulmonary artery and into the lungs. Alternatively, a PFO would allow the bubbles to enter the left side of the heart—which reveals the same path a clot might take to the brain.

Despite its commonality, not everyone needs a bubble study. The best action individuals can take is to undergo regular checkups with their physician.

During a physical examination, physicians are looking and listening for very specific signs. If they have a good ear, which is a key part of medical school training, they can pick up on a very specific type of murmur that might indicate PFO. Physicians routinely perform other maneuvers to detect potential problems, such as having a patient hold their breath or alternate squatting and standing—all while listening to the heart’s rhythm.

If the doctor suspects something is off, they’ll prescribe further testing. Family history of stroke or other clotting disorders may escalate advanced testing.

Treatment Options for PFO

Treatment for PFO relies on an individual’s unique circumstances. For example, if physicians determine there’s no extraneous risk of stroke after assessing family history and genetic indications, they may advise leaving the PFO as is.

If a family history of stroke, clotting disorders or additional risk factors do exist, physicians may recommend blood thinners or surgical intervention to repair the PFO. Fortunately, surgical advancements allow for less invasive procedures than in years past.

Bottom Line

Cryptogenic strokes don’t always get a definitive answer. That doesn’t mean your road to recovery ends there. No matter the cause of a stroke, the protocols of the Aviv Medical Program are designed to optimize recovery outcomes. A robust genetic panel can inform a great deal about why a stroke may have occurred—which is why genetic testing is an integral component of the program.

Contact us to learn more about the Aviv Medical Program and how it may benefit your stroke recovery and management.

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Recovering After a Stroke: Is it ever too late?