Underrecognized Role of Patent Foramen Ovale in Cryptogenic Ischemic Stroke among Young Adults in Sub-Saharan Africa: A Case Series from Burkina Faso

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Résumé

Background : Patent foramen ovale (PFO) is an uncommon cause of ischemic stroke (IS) overall but represents a frequent etiology of cryptogenic stroke in young adults. Data-t-on PFO-related stroke in sub-Saharan Africa remain scarce.
Objective : To de scribe the clinical, radiological, and echocardiographic characteristics of ischemic strokes probably related to PFO among adults aged ≤60 years in Ouagadougou, Burkina Faso.
Methods : We conducted a prospective, descriptive, multicenter case series from January 2021 to August 2023 in the neurology and cardiology departments of three university hospitals (UHs) in Ouagadougou (UH-Tengandogo, UH-Yalgado Ouédraogo, and UH-Bogodogo). Eligible patients were ≤60 years old with imaging-confirmed ischemic stroke and a high-risk PFO identified on contrast echocardiography (transthoracic and/or transesophageal). A Risk of Paradoxical Embolism (RoPE) score ≥4 was required for inclusion. Patients with other defined cardioembolic or atherosclerotic causes were excluded. Clinical, imaging, and echocardiographic data were analyzed using Epi Info 7.2.
Results: Most patients were young adults with few traditional vascular risk factors. Cortical infarcts predominated on neuroimaging. Echocardiography frequently revealed large shunts or an associated atrial septal aneurysm. No in-hospital mortality was recorded, and functional outcomes were favorable in most cases (modified Rankin Scale ≤2 at discharge and follow-up).
Conclusion : This inaugural series highlights that PFO may be an underrecognized cause of ischemic stroke in young adults in Burkina Faso. Routine contrast echocardiography and RoPE score assessment should be integrated into the diagnostic approach to cryptogenic stroke in resource-limited settings.

Mots-clés

patent foramen ovale ; ischemic stroke ; cryptogenic stroke ; rope score ; burkina faso