Stroke is a common cause of morbidity and mortality in adults worldwide. Because patent foramen ovale (PFO) is
commonly found in normal population, we need to identify a subset of cryptogenic stroke patients who are likely to have
experienced paradoxical embolization. Various factors need to be considered such as atrial anatomic variation (PFO size,
atrial septal aneurysm, eustachian valve anatomy), hemodynamic parameters, presence of venous thrombosis and presence
of hypercoagulable state. The presence of any of these findings increase the chance of PFO contributing to stroke. We describe
a 54-year-old patient with a history of well controlled hypertension and dyslipidemia who presented with 3 attacks of
expressive aphasia lasting 5 minutes each. General medical and neurological examinations were normal. Transesophageal
echocardiography with agitated saline injection revealed presence of PFO flap. Transcranial Doppler ultrasonography with
three agitated saline injections showed multiple unilateral microembolism signals in the M1 of left middle cerebral artery.
Aspirin was given as well as percutaneous endovascular PFO closure was performed with no immediate complication.
Patient has had no further attack of stroke after 6 months follow-up.

Keywords: Patent foramen ovale, Stroke, Atrial septal aneurysm, Paradoxical embolization