Paradoxical Thalamic Infarction via Patent Foramen Ovale in an Athletic Young Adult: A Case Report

Cryptogenic ischemic stroke represents a significant diagnostic challenge in young adults. A patent foramen ovale (PFO) is an increasingly recognized potential etiology, facilitating paradoxical embolism. We report the case of an 18-year-old athletic female who presented with acute neurological symptoms consistent with a right thalamic ischemic stroke, confirmed on magnetic resonance imaging (MRI). Extensive workup excluded common stroke causes, and the case fulfilled Embolic Stroke of Undetermined Source (ESUS) criteria. A PFO was identified via contrast transthoracic and transesophageal echocardiography (TTE and TEE). The patient underwent successful percutaneous PFO closure approximately four weeks after symptom onset and achieved full neurological recovery. This case highlights PFO as a crucial consideration in the differential diagnosis of cryptogenic stroke in young, otherwise healthy individuals. It underscores the importance of comprehensive investigation, including contrast echocardiography, and supports PFO closure in appropriately selected patients, such as those under 60 years of age with non-lacunar cryptogenic stroke and confirmed PFO, consistent with current evidence.