Dual potential embolic source detected in left atrium during hyperacute stroke

Paradoxical embolism through patent foramen ovale Embolism due to atrial fibrillation (AF) Embolism due to cerebrovascular atherosclerosis Embolic stroke of undetermined source Answer: B Both patent foramen ovale (PFO) and AF are well-established risk factors for stroke. Determining the most likely cause of stroke is critical because the secondary prevention strategy and prognosis are significantly different.1 2 PFO is more likely the cause of embolic stroke in patients at younger age and without other traditional risk factors.3 In older patients, particularly those with AF, PFO is much less likely the cause of stroke.4 This female patient with a low Risk of Paradoxical Embolism (RoPE) score indicates that the PFO is more likely incidental rather than pathogenic.3 This patient’s high CHA2DS2-VASc score suggests she was at higher risk of thromboembolism attributed to AF.4 Thus, PFO closure is not beneficial for her, but anticoagulation is. Ethics approval This study involves human participants but an ethics committee or institutional board exempted this study.