• Rodrigo Tavares Brisson, Josevânia Fulgêncio de Lima Arruda, Liene Duarte Silva, Dilermando Leal Júnio de Jesus, Viviane Flumignan Zetola, and Marcia Aparecida Camacho Kauffmann Nogueira.
• Division of Neurology, Hospital Naval Marcílio Dias, Rio de Janeiro, Rio de Janeiro 20725-090, Brazil.
• Mil Med. 2023 Mar 20; 188 (3-4): e885e889e885-e889.

AbstractWe report two cases of Brazilian patients (a 22-year-old male and a 48-year-old male) with ischemic stroke, whose arterial vascular study and echocardiographic investigation did not reveal any steno-occlusive arterial disease or typical cardioembolic finding, such as atrial fibrillation or myocardial dysfunction. A transcranial Doppler ultrasound and a transesophageal echocardiogram showed a patent foramen ovale (PFO), and the laboratory screening for coagulation abnormalities showed heterozygosity for MTHFR C677T and A1298C in one of the patients and heterozygosity for factor V Leiden gene mutations in the other patient. The significance of the association of PFO with Methylenetetrahydrofolate (MTHFR) C677T and A1298C variants or factor V Leiden mutation is discussed as a possible cause of ischemic stroke through paradoxical embolism from a venous source. There is a high prevalence of these two mentioned conditions in the general population, so we discuss two cases in which indication for anticoagulant therapy or percutaneous closure of PFO prevails.© The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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