![\"Pretreatment\"](\"http:\/\/web.colby.edu\/bi265-humananatomyatcolby\/files\/2014\/01\/Pretreatment.jpg\")
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Pretreatment (above) and posttreatment (below) angiography<\/strong><\/p>\n An ischemic stroke results from a blockage of a blood vessel that supplies the brain. This lack of blood results in oxygen deprivation of the brain; this is what we know as a stroke. There are two main types, cerebral thrombosis and embolisms. Thromboses are formed at the site of the blockage and while embolisms originate somewhere else in the body and travel to the site of the blockage. Some identifying risk factors of stroke include hypertension, diabetes and lipid issues. Many other diseases and conditions can also increase the risk of stroke, for instance patent foramen ovales (PFO) have a high correlation with strokes.<\/p>\n Retrieved thrombus and MERSI retriever. <\/strong><\/p>\n PFOs result from a failure of the neonatal hole in the heart between the right and left atrium to close post birth. Normally the closure of which results in what we know as the fossa ovalis. PFOs can allow clots to enter the aorta, where the clot has the potential to travel to the brain possibly resulting in ischemic strokes. A surprising 14% of all strokes occur in children and young adults (Yager et al.). The majority of which are ischemic strokes, with a lesser incidence of hemorrhagic strokes.<\/p>\n There are over 18 Cardiac causes of stroke in young adults. However, of all these causes of cardiac strokes in young adults, 37% of the patients have a PFO. Unlike many of the causes, PFO\u2019s are source of low and uncertain risk because just having a PFO doesn\u2019t directly relate to a person having a stroke, since 1 in 5 Americans have PFO\u2019s and many of these people go through life with no cardiac issues. Along with a PFO, a person has to have clot form in their blood, and their blood pressure must be high in the right atrium to build enough pressure to push open the flap and send the clot through to the left atrium. This is relevant to our case because our patient had a PFO and got it closed and had no further issues with ischemic strokes. He has made a full recovery but did come very close to death due to the late diagnosis. This was not a surprise because people under 50 are often misdiagnosed since the general public and clinicians are unaware of how often young adults do have strokes and it is not their first assumption.<\/p>\n Common signs are numbness in face or extremities, trouble speaking, disturbed vision, trouble with motor control, dizziness, and headache. Our patient presented with ataxia or impaired motor control, blurred vision, and dysarthria or slurred speech. Initially receiving clinicians searched for a tumor and other sources due to the young age of the patient. After, the rapid onset of symptoms they began to search for other causes. Within 20 minutes of admission to the original receiving hospital, the patient progressed from difficulty walking to needing a wheelchair, within hours he entered into a coma and was promptly transferred to Mass General via airlift. Doctors at Mass General made the correct diagnosis of stroke after performing diagnostic tests including CT scans and MRIs, because the patient was diagnosed with a stroke past the three hour window, he was treated with an endovascular reperfusion, or a minimally invasive clot retrieval surgery. The other options were both made use of pharmacological agents and ran the risk of cerebral hemorrhage. This is due to the possible malignant interaction between the drug and the infarcted tissue surrounding the occlusion. A Merci retriever was guided into the femoral artery to the location of the clot. The retrieved thrombus was 1.8 cm in length. The patient made a full recovery and his PFO closed after a year. He now lives a normal life with an aspirin regimen.<\/p>\n Through this case study, we hope to raise clinician awareness of the rate of strokes in young adults. As clinicians become more aware hopefully there won\u2019t be as many late and misdiagnoses that lead to fewer treatment options, higher risk of fatality and increased treatment costs. Incidence of strokes in people under 34 has increased in recent years, particularly in males. Therefore, it is important that clinicians become more aware and have better clinical cues in order to more quickly work up to the stroke diagnosis, as this problem will only increase.<\/p>\n <\/p>\n Works cited:<\/p>\n <\/p>\n George MG, Tong X, Kuklina EV, Labarthe DR. Trends in stroke hospitalizations and associated risk factors among children and young adults, 1995-2008. Ann Neurol2011;70:713-721. http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21898534?dopt=Abstract<\/a>. Accessed 13 Jan 2014.<\/p>\n <\/p>\n “Ischemic Strokes (Clots).” Ischemic Strokes (Clots). American Heart Association, American Stroke Association. N.p., n.d. Webhttp<\/a>:\/\/www.strokeassociation.org\/STROKEORG\/AboutStroke\/TypesofStroke\/IschemicClots\/Ischemic-Strokes-<\/a>Clots_UCM_310939_Article.jsp<\/a>. Accessed 18 Jan. 2014.<\/p>\n <\/p>\n Ji R, Schwamm LH, Muhammad P, Singhal AB. \u201cIschemic stroke and TIA in young adults: risk factors, diagnostic yield, neuroimaging and thrombolysis. Arch Neurol (in press).\u201d JAMA Neurol. 2013 Jan;70(1):51-7. http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23108720<\/a>. Accessed 14 Jan 2014.<\/p>\n <\/p>\n Krasuski, R. M.D., Tuzcu, M. M.D., Kapadia, S., M.D. \u201cDisease and conditions: Patent Foramen Ovale.\u201d Clevelandclinic.org. Jan 2012. http:\/\/my.clevelandclinic.org\/heart\/disorders\/congenital\/pfo.aspx<\/a>. Accessed 14 Jan 2014.<\/p>\n <\/p>\n<\/a><\/p>\n<\/a><\/p>\n