The Intersection of Psychiatry and Neurology in Young Adults: The Hidden Link Between Patent Foramen Ovale and Stroke

In young patients presenting with acute neurological symptoms, distinguishing between psychogenic and organic causes is crucial. Patent foramen ovale (PFO) is a significant factor that can lead to cardioembolic stroke in young individuals. This case report presents a patient who was initially misdiagnosed with a psychogenic disorder but was later found to have suffered a cardioembolic stroke. A 17-year-old female presented with speech disturbances (stuttering, difficulty in articulation) and became emotional during history taking. Her past medical history revealed recurrent similar episodes. Neurological examination was normal; thus, a psychogenic etiology was suspected, and she was discharged after benzodiazepine infusion. However, she returned in the evening with right-sided numbness in her arm and leg, was again diagnosed with a psychogenic disorder, and received another benzodiazepine infusion. Later that night, she fell while attempting to use the restroom and was brought to the emergency department with speech impairment and right-sided weakness. This time, a neurological evaluation revealed left central facial paralysis, right hemiparesis, dysarthria, and cerebellar dysfunction. Brain MRI showed bilateral lacunar ischemic infarcts. A cardiology evaluation suspected PFO, which was confirmed via transesophageal echocardiography. The patient was diagnosed with acute ischemic stroke, started on fractionated heparin therapy, and underwent PFO closure five days later. Although psychogenic disorders are common in young patients, organic causes must be ruled out in cases of acute neurological deficits. PFO is a leading cause of cryptogenic strokes in young adults, often presenting with recurrent transient ischemic attacks (TIAs). Overlooking a cardioembolic etiology can lead to diagnostic and treatment delays, potentially worsening outcomes. Unexplained neurological symptoms in young patients should be thoroughly investigated before attributing them to psychogenic causes. Cardioembolic conditions such as PFO can be successfully managed with early diagnosis and appropriate intervention.