Ischemic stroke during sexual intercourse: a report of 4 cases in persons with patent foramen ovale.

BACKGROUND

The association between patent foramen ovale (PFO) and stroke risk in young adults is controversial and poorly understood. Paradoxical embolization through a PFO represents a possible mechanism by which PFO might predispose to stroke.

OBJECTIVE

To describe 4 patients with PFO who experienced the onset of ischemic stroke during sexual intercourse.

DESIGN

Case series.

SETTING

Tertiary referral stroke clinic.

PATIENTS: Consecutive patients experiencing stroke during intercourse.

RESULTS

All 4 patients were found to have PFO. Despite a thorough evaluation, no other etiology for stroke was identified.

CONCLUSION

We suggest that paradoxical embolization through a PFO due to elevated intrathoracic pressure during sexual activity could be a potential mechanism for stroke in these patients.