Thrombolysis in The First Trimester of Pregnancy in Patent Foramen Ovale Related Ischemic Stroke

Background: Patent foramen ovale is described to be responsible for a high percent of ischemic stroke in young adults. Furthermore, ischemic stroke is considered to be one of the main pregnancy-related risk factors, contributing to maternal death. Minor stroke is however successfully managed with dual antiplatelet treatment, but presence of vascular occlusion represents a management challenge.

Case presentation: We describe the case of a 29-year-old woman, who presented with an acute onset ischemic stroke with facial weakness and sensory symptoms in the left arm. Imaging showed signs of an embolic stroke with a distal middle cerebral artery occlusion not eligible for thrombectomy. The patient was successfully treated with thrombolysis. Diagnostic work-up revealed a considerable patent foramen ovale, which was occluded 13 months after delivery. The use of the PASCAL and ROPE-score is discussed to grade the clinical relevance of the patent foramen ovale in combination with the procoagulant state during pregnancy in our patient.

Conclusion: Patent foramen ovale should be taken into account in ischemic stroke occurring during pregnancy in young women, especially in the first trimester. Possible further progression can be considered during the treatment decision regarding thrombolysis and/or endovascular intervention even in patients with a low NIHSS score