Cardioembolic stroke: Who is the guilty?

A young woman was referred following a transient ischemic attack due to suspect patent foramen ovale. At the diagnostic workup a spontaneous mild right-to-left atrial shunt owing to fenestrated aneurysmal septum was found. However, also a large arteriovenous malformation of the left lung was also imaged. At interventional cardiac catheterization, both malformations were closed using an Amplatzer Cribriform occluding device and a Amplatzer Vascular Plug II, respectively. In Conclusion, patent foramen ovale is just one of the potential causes of cardioembolic stroke and a thorough diagnostic workup is mandatory after a cryptogenic stroke to rule out any additional source of paradoxical embolism. © 2011 Italian Federation of Cardiology.