{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T16:00:17Z","timestamp":1777046417066,"version":"3.51.4"},"reference-count":10,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Sickle\u2010cell disease (SCD) is characterized by abnormal hemoglobin (Hb) polymerization, leading to erythrocyte sickling and microvascular obstruction. Elevated fetal hemoglobin (HbF) levels are often associated with reduced\u2014but still possible\u2014vaso\u2010occlusive complications. We report the case of a 22\u2010year\u2010old South Asian male with SCD and persistently elevated HbF (~23%) who presented with transient right\u2010sided numbness and visual disturbances. Brain MRI confirmed acute ischemic infarcts, prompting urgent red blood cell exchange transfusion. Comprehensive investigations for causes of stroke revealed a patent foramen ovale on echocardiogram, suggesting paradoxical embolism as the etiology. This case highlights diagnostic challenges in SCD patients with high HbF presenting with stroke. While elevated HbF levels are considered protective against vaso\u2010occlusive events, this patient's presentation challenged this assumption. The identification of a cardiac shunt prompted reconsideration of the stroke mechanism. In conclusion, clinicians must maintain a broad differential diagnosis and pursue comprehensive evaluations in SCD patients with neurological symptoms.<\/jats:p>","DOI":"10.1002\/ccr3.72618","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T14:43:48Z","timestamp":1777041828000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stroke From Paradoxical Embolism in a Young Patient With Sickle\u2010Cell Disease and High Fetal Hemoglobin: A Diagnostic Challenge"],"prefix":"10.1002","volume":"14","author":[{"given":"Yi Hui","family":"Luo","sequence":"first","affiliation":[{"name":"Department of Internal Medicine McGill University  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Navid","family":"Zuberi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine McGill University  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelo","family":"Rizzolo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine McGill University  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret","family":"Warner","sequence":"additional","affiliation":[{"name":"Division of Hematology McGill University Health Centre  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephane","family":"Isnard","sequence":"additional","affiliation":[{"name":"Research Institute of the McGill University Health Centre  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9897-7589","authenticated-orcid":false,"given":"Jean\u2010Pierre","family":"Routy","sequence":"additional","affiliation":[{"name":"Division of Hematology McGill University Health Centre  Montreal Quebec Canada"},{"name":"Research Institute of the McGill University Health Centre  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"issue":"1","key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1182\/blood-2011-03-325258","article-title":"Fetal Hemoglobin in Sickle Cell Anemia","volume":"118","author":"Akinsheye I.","year":"2011","journal-title":"Blood"},{"issue":"24","key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"2517","DOI":"10.1182\/blood.2023023031","article-title":"Rates of Strokes in Californians With Sickle Cell Disease in the Post\u2010STOP Era","volume":"144","author":"Oluwole O.","year":"2024","journal-title":"Blood"},{"issue":"1","key":"e_1_2_13_4_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1182\/hematology.2024000678","article-title":"Sickle Cell Disease in India: The Journey and Hope for the Future","volume":"2024","author":"Gupta K.","year":"2024","journal-title":"Hematology. American Society of Hematology. Education Program"},{"issue":"2","key":"e_1_2_13_5_1","doi-asserted-by":"crossref","first-page":"109","DOI":"10.4103\/0377-4929.118699","article-title":"Microcytic Hypochromic Anemia: Should High Performance Liquid Chromatography Be Used Routinely for Screening Anemic and Antenatal Patients?","volume":"56","author":"Philip J.","year":"2013","journal-title":"Indian Journal of Pathology and Microbiology"},{"issue":"2","key":"e_1_2_13_6_1","doi-asserted-by":"crossref","first-page":"257","DOI":"10.4103\/ajts.ajts_62_22","article-title":"Prevalence of Hemoglobinopathies Using High\u2010Performance Liquid Chromatography as Diagnostic Tool in Anemic Patients of Tertiary Care Center of Western India","volume":"18","author":"Singh V.","year":"2024","journal-title":"Asian Journal of Transfusion Science"},{"issue":"2","key":"e_1_2_13_7_1","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1111\/j.1365-2141.2011.08916.x","article-title":"Fetal Haemoglobin Levels and Haematological Characteristics of Compound Heterozygotes for Haemoglobin S and Deletional Hereditary Persistence of Fetal Haemoglobin","volume":"156","author":"Ngo D. A.","year":"2012","journal-title":"British Journal of Haematology"},{"issue":"4","key":"e_1_2_13_8_1","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1182\/blood-2013-09-528067","article-title":"Fetal Hemoglobin in Sickle Cell Anemia: A Glass Half Full?","volume":"123","author":"Steinberg M. H.","year":"2014","journal-title":"Blood"},{"key":"e_1_2_13_9_1","doi-asserted-by":"crossref","DOI":"10.1182\/blood-2019-122387","article-title":"High Hemoglobin F in Sickle Cell Disease: Waning Protection With Age","volume":"134","author":"Tolu S. S.","year":"2019","journal-title":"Blood"},{"key":"e_1_2_13_10_1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/0002-9343(60)90003-6","article-title":"Hereditary Persistence of Fetal Hemoglobin. A Family Study","volume":"29","author":"EC H.","year":"1960","journal-title":"American Journal of Medicine"},{"issue":"1","key":"e_1_2_13_11_1","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1161\/STROKEAHA.123.040546","article-title":"Patent Foramen Ovale Management for Secondary Stroke Prevention: State\u2010of\u2010the\u2010Art Appraisal of Current Evidence","volume":"55","author":"Sposato L. 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