{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T15:21:12Z","timestamp":1771687272102,"version":"3.50.1"},"reference-count":12,"publisher":"Aerospace Medical Association","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:p><jats:bold>BACKGROUND:<\/jats:bold> Stroke in young patients is frequently associated with a patent foramen ovale (PFO). Controversy exists over whether the PFO is a cause, a risk factor, or an incidental finding. Estimating the individualized risk of stroke recurrence has been difficult to ascertain. This has implications for aeromedical certification for pilots following stroke recovery.<\/jats:p>\n<jats:p><jats:bold>CASE REPORT:<\/jats:bold> A 28-yr-old male flight instructor presented with sudden onset unilateral facial paresthesia, hand weakness, and blurred vision, accompanied by gradual onset bilateral headache. While the cranial symptoms resolved, left hand weakness persisted for 3 d. MRI revealed two punctate ischemic foci in the right precentral gyrus and superior parietal lobe. A transesophageal echocardiogram revealed a PFO with a small bidirectional shunt. His cardiologist and neurologist advised the PFO was unlikely to have caused his stroke and estimated an annual recurrence rate of &lt; 1.8%. He was treated medically and declined PFO closure. He was able to return to flying light-sport aircraft. However, an enduring copilot restriction for general aviation activities was placed on his Class 1 and 2 medical certificates.<\/jats:p>\n<jats:p><jats:bold>DISCUSSION:<\/jats:bold> This case highlights the difficulty in determining individualized recurrence risks for pilots recovering from a stroke associated with a PFO. While medical treatment does reduce the risk of recurrence, PFO closure provides marginal additional benefit in certain patients with a risk of side effects. Contemporary evidence-based risk scoring systems combined with echocardiography findings may be used together to better risk stratify patients and suitability for medical aviation recertification.<\/jats:p>\n<jats:p><jats:bold>Rengel AC, Gericke C. <jats:italic>Embolic ischemic cortical stroke in a young flight instructor with a small patent foramen ovale<\/jats:italic>. Aerosp Med Hum Perform. 2024; 95(10):784\u2013787.<\/jats:bold><\/jats:p>","DOI":"10.3357\/amhp.6483.2024","type":"journal-article","created":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T00:31:12Z","timestamp":1729125072000},"page":"784-787","source":"Crossref","is-referenced-by-count":2,"title":["Embolic Ischemic Cortical Stroke in a Young Flight Instructor with a Small Patent Foramen Ovale"],"prefix":"10.3357","volume":"95","author":[{"given":"Anthony C.","family":"Rengel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Gericke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1911","reference":[{"issue":"7","key":"B1","series-title":"Stroke.","first-page":"2349","article-title":"Patent foramen ovale in cryptogenic stroke","volume":"40","author":"Alsheikh-Ali AA","year":"2009","unstructured":"Alsheikh-Ali AA, Thaler DE, Kent DM. Patent foramen ovale in cryptogenic stroke. Stroke. 2009; 40(7):2349\u20132355. 10.1161\/STROKEAHA.109.547828"},{"issue":"1","key":"B2","series-title":"Stroke.","first-page":"236","article-title":"Patent foramen ovale management for secondary stroke prevention: state-of-the-art appraisal of current evidence","volume":"55","author":"Sposato LA","year":"2024","unstructured":"Sposato LA, Albin CSW, Elkind MSV, Kamel H, Saver JL,  Patent foramen ovale management for secondary stroke prevention: state-of-the-art appraisal of current evidence. Stroke. 2024; 55(1):236\u2013247. 10.1161\/STROKEAHA.123.040546"},{"issue":"2","key":"B3","series-title":"J Am Coll Cardiol.","first-page":"440","article-title":"Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based study","volume":"47","author":"Meissner I","year":"2006","unstructured":"Meissner I, Khandheria BK, Heit JA, Petty GW, Sheps SG,  Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based study. J Am Coll Cardiol. 2006; 47(2):440\u2013445. 10.1016\/j.jacc.2005.10.044"},{"issue":"24","key":"B4","series-title":"N Engl J Med.","first-page":"1740","article-title":"Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both","volume":"345","author":"Mas JL","year":"2001","unstructured":"Mas JL, Arquizan C, Lamy C, Zuber M, Cabanes L,  Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med. 2001; 345(24):1740\u20131746. 10.1056\/NEJMoa011503"},{"key":"B5","series-title":"Front Neurol.","first-page":"567","article-title":"Patent foramen ovale in cryptogenic ischemic stroke: direct cause, risk factor, or incidental finding?","volume":"11","author":"Ioannidis SG","year":"2020","unstructured":"Ioannidis SG, Mitsias PD. Patent foramen ovale in cryptogenic ischemic stroke: direct cause, risk factor, or incidental finding? Front Neurol. 2020; 11:567. 10.3389\/fneur.2020.00567"},{"issue":"7","key":"B6","series-title":"Neurology.","first-page":"619","article-title":"An index to identify stroke-related vs. incidental patent foramen ovale in cryptogenic stroke","volume":"81","author":"Kent DM","year":"2013","unstructured":"Kent DM, Ruthazer R, Weimar C, Mas JL, Serena J,  An index to identify stroke-related vs. incidental patent foramen ovale in cryptogenic stroke. Neurology. 2013; 81(7):619\u2013625. 10.1212\/WNL.0b013e3182a08d59"},{"issue":"2","key":"B7","series-title":"Eur Heart J.","first-page":"120","article-title":"Percutaneous closure of patent foramen ovale in patients with cryptogenic embolism: a network meta-analysis","volume":"36","author":"Stortecky S","year":"2015","unstructured":"Stortecky S, da Costa BR, Mattle HP, Carroll J, Hornung M,  Percutaneous closure of patent foramen ovale in patients with cryptogenic embolism: a network meta-analysis. Eur Heart J. 2015; 36(2):120\u2013128. 10.1093\/eurheartj\/ehu292"},{"issue":"10","key":"B8","series-title":"Stroke.","first-page":"3119","article-title":"Risk of paradoxical embolism (RoPE)\u2014estimated attributable fraction correlates with the benefit of patent foramen ovale closure: an analysis of 3 trials","volume":"51","author":"Kent DM","year":"2020","unstructured":"Kent DM, Saver JL, Ruthazer R, Furlan AJ, Reisman M,  Risk of paradoxical embolism (RoPE)\u2014estimated attributable fraction correlates with the benefit of patent foramen ovale closure: an analysis of 3 trials. 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