SHM Converge Scientific Abstract ePoster Gallery-Thalamic Stroke in Young Adult With Pfo and Finasteride Use

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This case describes a 21-year-old man with no significant past medical history who presented with short-term memory problems and mild speech changes. Brain imaging showed a left thalamic infarct, confirming an acute ischemic stroke. He had no typical cerebrovascular risk factors, and initial testing was unrevealing: CT angiography, venous Dopplers, CT pulmonary embolism study, and hypercoagulable workup were all negative. Transthoracic echocardiography was normal, but transesophageal echocardiography identified a patent foramen ovale (PFO), suggesting a possible source of paradoxical embolism. The patient also had a history of finasteride use for male pattern baldness, which the authors note may increase testosterone and downstream estrogen levels, potentially contributing to thrombosis, though this association remains controversial.<br /><br />He was treated with antiplatelet therapy and statin medication and was referred for PFO closure, which was successfully performed. At follow-up, he was asymptomatic and advised to stop finasteride.<br /><br />The report emphasizes that ischemic stroke in young adults is uncommon but important, and cryptogenic stroke should prompt evaluation for PFO. It also highlights finasteride as a possible but uncertain prothrombotic factor. The authors conclude that young stroke patients should undergo a thorough search for cardioembolic and hypercoagulable causes, including PFO assessment, and that PFO closure may benefit selected younger patients. They also recommend discontinuing finasteride when stroke occurs because of its possible association with thrombosis.

Asset Subtitle

Sai Rakshith Gaddameedi

Meta Tag

Author List Anoohya Vangala, Mahrukh Khan, Pratik Panchal, Reshma Abraham, Sai Rakshith Gaddameedi, Shazia Shah, Vandana Bandari

Category Clinical Vignettes

Concept Cryptogenic Ischemic Stroke

Concept Patent Foramen Ovale

Concept Cardioembolic Source

Concept Thalamic Infarct

Concept Magnetic Resonance Imaging

Distinguished Non-Finalist

Presenter Organization RWJBH/Monmouth Medical Center

Presenting Author Sai Rakshith Gaddameedi

Track Adult

Keywords

ischemic stroke

young adult

left thalamic infarct

cryptogenic stroke

patent foramen ovale

paradoxical embolism

transesophageal echocardiography

finasteride

thrombosis

PFO closure

Cryptogenic Ischemic Stroke

Patent Foramen Ovale

Cardioembolic Source

Thalamic Infarct

Magnetic Resonance Imaging