Psychiatric Symptoms and Benzodiazepine Use Mask a Patent Foramen Ovale-Related Stroke: A Cautionary Tale

  • Manuel Martins Barbosa Unidade Local Saude Alto Minho, EPE, Portugal
  • Elsa Araújo Unidade Local Saude Alto Minho, EPE, Portugal
  • Marta Pereira Unidade Local Saude Alto Minho, EPE, Portugal
  • Rui Marques Costa Centro Hospitalar de Lisboa Ocidental, EPE, Portugal
  • Alejandro Ballvé Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
  • Marta Rubiero Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
  • Carlos A Molina Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain

Keywords

Psychiatric mimics, patent foramen ovale, PFO closure, PFO medical therapy, stroke in a young adult

Abstract

Neurological and psychiatric diseases often present with overlapping features. Patients are sometimes seen by internal medicine, neurology and psychiatry clinicians and time can be important for determining whether a condition is organic or not. The authors present the case of a 31-year-old woman admitted to the emergency department with altered mental status and incomprehensible speech. She had a previous history of anxiety and smoking and was under therapy with benzodiazepines and combined hormonal contraceptives. After an acute neurological disorder was ruled out, the patient was transferred to the psychiatry department, where she was re-evaluated after 12 hours of observation and benzodiazepine washout. As speech impairment and confusion were still present, she was transferred to the Stroke Unit. A bilateral thalamic lesion containing a small focal haemorrhage and a moderate grade right-to-left shunt were identified. A patent foramen ovale was confirmed leading to the final diagnosis of acute ischaemic infarction secondary to a paradoxical embolism. Medical therapy was preferred over percutaneous closure. Risk factors were removed (smoking and hormonal contraceptives), and after the patient recovered completely acetylsalicylic acid 100 mg daily was initiated.

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  • Published: 2019-07-05

    Issue: LATEST ONLINE (view)

    Section: Articles

    How to cite:
    Barbosa, M., Araújo, E., Pereira, M., Marques Costa, R., Ballvé, A., Rubiero, M., & Molina, C. (2019). Psychiatric Symptoms and Benzodiazepine Use Mask a Patent Foramen Ovale-Related Stroke: A Cautionary Tale. European Journal of Case Reports in Internal Medicine, 2. https://doi.org/https://doi.org/10.12890/2019_001120