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Patent Foramen Ovale and Cryptogenic Stroke in Older Patients

Patent Foramen Ovale and Cryptogenic Stroke in Older Patients. The NEW ENGLAND JOURNAL of MEDICINE November 29, 2007 Michael Handke, M.D., Andreas Harloff, M.D., Manfred Olschewski, M.Sc., Andreas Hetzel, M.D., and Annette Geibel, M.D. PREPARED BY CENDRELLA HOJEILY PGYII. I- Background.

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Patent Foramen Ovale and Cryptogenic Stroke in Older Patients

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  1. Patent Foramen Ovale and Cryptogenic Stroke in Older Patients The NEW ENGLAND JOURNAL of MEDICINE November 29, 2007 Michael Handke, M.D., Andreas Harloff, M.D., Manfred Olschewski, M.Sc., Andreas Hetzel, M.D., and Annette Geibel, M.D. PREPARED BY CENDRELLA HOJEILY PGYII

  2. I- Background

  3. Studies to date have shown an association in patients younger than 55 years of age. Stroke 1993This association has not been established in patients 55 years of age or older. Neuro 2000

  4. PATENT FORAMEN OVALE

  5. STROKE • Definition • TOAST classification: • Cardio embolic • Large-artery atherosclerosis • Lacunar • Other etiology • Undetermined etiology: CRYPTOGENIC

  6. AGING

  7. II- Methods

  8. INCLUSION CRITERIA:596 patients1- Suspicion of ischemic stroke2- Age between 18-85 EXCLUSION CRITERIA:1- Unable to do TEE( 37)2- Decline TEE (24)3- Diagnosis different than ischemia (32)

  9. Stroke workup:1- CTscan and/ or MRI/MRA2- Duplex sono3- Angiography4- EKG5- TTE 6- HOLTER (afib)7- ESR ANA APL PROT C&S AT III TEE with saline or gelatin contrast (4 CYCLES)

  10. III- Results

  11. IV- Conclusions

  12. There is an association between the presence of patent foramen ovale and cryptogenic stroke in both older patients and younger patients. These data suggest that paradoxical embolism is a cause of stroke in both age groups.

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