Common But Little-known Condition Can Cause Stroke

Thirty-five year old Laura Johnson had given birth to her second son three and a half months prior to suffering a stroke while living out of the country.
“I was reading to my son and trying to get him to eat his breakfast. All of a sudden I lost the ability to talk and move,” she told a reporter from KHOU11, the CBS affiliate in Houston. “I was just wondering, when is this going to pass?
When she returned to the U.S. she checked in with Dr. Anjail Sharrief, a neurologist with the University of Texas Health who discovered that Johnson had a hole in her heart called a patent foramen ovale (PFO).
Dr. Sharrief told Johnson that all babies are born with a hole in their heart but 75 percent of the time it closes in infancy.
“But, for a quarter of people, it stays open. For most of them, they’ll never have a problem with it,” said Dr. Sharrief. And, then there are people like her who, without any warning symptoms, have a stroke.
The Cleveland Clinic explains that before a baby is born, it doesn’t use it’s lungs to get blood rich in oxygen. It comes from the mother’s placenta and is delivered through the umbilical cord.
“The foramen ovale normally closes as blood pressure rises in the left side of the heart after birth. Once it is closed, the blood flows to the lungs to get oxygen before it enters the left side of the heart and gets pumped to the rest of the body.
“A patent foramen ovale means the foramen ovale did not close properly at birth, so there is still an opening in the septum. In most cases, the PFO does not stay open at all times. Instead, it’s more like a flap that opens when there is higher pressure than normal in the chambers on the right side of the heart.
“Situations that can cause greater pressure include straining during bowel movements, coughing and sneezing. When the pressure gets high enough, blood may move from the right atrium to the left atrium,” Cleveland Clinic said.
There are several stories online about strokes caused by PFO, including one about a 19-year-old woman who was also treated by Dr. Sharrief.  One that was particularly interesting was on Mayo Clinic’s website about a thirty-nine year-old woman who is a healthcare professional herself who was aware of what was happening to her, but was unable to speak.
“I was worried they wouldn’t believe I was having a stroke,” Sherry Pinkstaff, PhD said. “I’m young, with no obvious risk factors and I don’t look like the typical stroke victim.”
Fortunately, the EMS staff did recognize her symptoms and the stroke team at Mayo Clinic confirmed that she had “several blood clots, many in distal branches of her brain, which were affecting not only her speech but her entire communications center as well as the right side of her body.”
Dr. Sharrief said that roughly 100,000 Americans suffer PFO-related strokes each year and that, as mentioned before, most of those patients won’t know they are at risk. He said that in patients having a stroke “an echocardiogram (ultrasound of the heart) should be ordered to help determine whether the stroke may have been related to PFO.
So, what if it is related to PFO? The neurologist and cardiologist will figure out if the patient is a candidate for surgical closure, or if he or she can be treated with blood thinning medications that don’t seal the flap, but may control the formation of blood clots to prevent further episodes.
Everyone should know the signs of stroke. Call 911 immediately if a person has trouble with speaking and understanding. Slurred words or confusion are a red flag, as is numbness, weakness or paralysis on one side of the body. Blurred vision in one or both eyes is a symptom so is a sudden severe headache accompanied by vomiting and dizziness or loss of balance and/or coordination.
Don’t wait expecting symptoms to stop. Every minute counts. Mayo Clinic isn’t kidding when they say, “The longer a stroke goes untreated, the greater the potential for brain damage and disability.”
Kathy Hubbard is a member of Bonner General Health Foundation Advisory Council. She can be reached at [email protected].