• Yiwen Zhang, Ruihan Zhu, Zhenzhen Yu, Songqi Hou, and Jianping Niu.
• Neurology Department, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China.
• Medicine (Baltimore). 2023 Mar 17; 102 (11): e32996e32996.

BackgroundTransthoracic echocardiography (TTE) is the most commonly used screening method for cardiac structural abnormalities. However, it may lead to a missed diagnosis of partial patent foramen ovale (PFO)-associated stroke.Case PresentationA 60-year-old male was admitted to the hospital for recurrent left limb weakness with or without slurred speech for 14 months. No stroke-related cardiac structural abnormality was detected during repeated TTE, and the patient was diagnosed with cerebral small vessel disease. Finally, right-to-left shunt was detected by contrast-enhanced transcranial Doppler. Subsequently, the patient was diagnosed with PFO-associated stroke by transesophageal echocardiography and contrast transesophageal echocardiography.ConclusionsTTE has a low detection rate of PFO, such that it is easily missed. Contrast-enhanced transcranial Doppler is easy to operate and should be promoted as a supplementary measure to stroke etiological investigation and primary PFO screening.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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