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Entries in PFO (2)

Wednesday
May292013

Arizona Twins Suffer Strokes at 26, Just Months Apart

Courtesy Barrow Neurological Institute(TEMPE, Ariz.) -- Kathryn Tucker, a senior care coordinator for an Arizona insurance company, had just gone to bed when she felt a sharp pain the back of her head on the right side before her vision went out and she went numb.

Her brother was at her Tempe, Ariz., apartment and got her to the hospital where doctors at first dismissed her symptoms as a migraine with aura. But Tucker, only 26, was having a stroke.

"I was absolutely terrified," said Tucker, who was sent home from the emergency room that day in July 2012 without medical intervention.

"I slept for three days straight," she said. "Then, when I woke up, my vision was horrible. Everything was distorted and one-dimensional. I could barely get around."

Her health deteriorated so she ended up going to an urgent care facility, where tests showed she had, indeed, had a stroke.

Nine months later to the day, her twin sister, Kimberly Tucker, suffered a stroke in exactly the same way, except on the left side. Kimberly Tucker had left school in Tucson to take care of her sister after her stroke. Then in April, their roles reversed.

The Tucker girls are fraternal twins and do not share the same DNA, and there is no family history of stroke, so doctors said there is no genetic cause. Both suffered a stroke on opposite sides of the occipital lobe, which sends visual input from the brain to the retinas.

"Honestly, it's rare for us to actually evaluate two sisters who've had strokes within months of each other," said Dr. Joni Clark, a vascular neurologist at Barrow Neurological Institute in Phoenix. "If they had a family history, it would not be a surprise. It's quite uncommon."

Stroke is a leading cause of death in the United States, killing nearly 130,000 Americans each year, according to the Centers for Disease Control and Prevention, which observes National Stroke Month in May.

About one-third of strokes are believed to occur in people younger than 65. For those younger than 45, the stroke risk has jumped 14 to 20 percent, according to Clark.

"We see this mainly among young people who have risk factors that you should see in elderly patients.

"Here at Barrow, we see a huge population of stroke patients -- and, in my own experience, which is anecdotal, I see a fair number of young people with stroke," said Clark. "The majority are spontaneous."

Obesity, which leads to diabetes, high blood pressure and high cholesterol, is a risk.

"You'd also be surprised how many young adults don't exercise," said Clark. "It's sad, because the rise is due to good, old stroke risk factors that shouldn't happen when they are young."

The twins also shared lifestyle traits that doctors said are linked to an increase in the incidence of strokes among young people. Both girls were smokers. They were also migraine sufferers and had been taking birth control pills.

It was discovered later that Kathryn Tucker had a PFO, or patent foramen ovale, a small hole in the heart that may have contributed to her stroke.

"There were several things that probably all together put Kathryn at risk," said Clark, who treated Kathryn Tucker, but not her sister.

Kathryn Tucker said her prognosis is "really good" now that she has stopped smoking and taking the pill.

The twins said they were also worried about their overuse of caffeinated energy drinks -- three to four a day, although there is no medical evidence linking those drinks to stroke.

"Don't think you are impervious to stroke," said Kimberly Tucker, who is still undergoing therapy. "We think we are invincible until we are not. This taught us a huge lesson that we are not guaranteed great health and we need to take care of our bodies."

Kimberly Tucker, unlike her sister, did not have a PFO and was an avid runner.

"On the day of my stroke I did a 5K run," she said. "I was feeling extra thirsty the whole time and went home to take a nap."

When she woke up, Kimberly Tucker felt a sharp pain on the left side of the back of her head.

"My vision closed in almost completely," she said. "I wasn't making a lot of sense and was not able to form complete thoughts. But I knew I was having a stroke."

Remembering what her twin sister had gone though, she immediately called 911, then her sister, who told her to take her blood thinners, a move that might have saved her life.

"I instantly knew I had a stroke because I was suffering from many of the same symptoms as my sister," says Kimberly Tucker. "The EMTs told me that the chance of both me and my sister having a stroke this young was that of being struck by lightning twice. They thought I was suffering from dehydration or heat stroke."

Later, doctors discovered Kimberly Tucker had arrhythmia, which may have been a contributing factor to her stroke.

Today, both girls are doing well after occupational and speech therapy, though they still have some visual deficits and are not allowed to drive.

"I still notice some weakness when I am tired," Kathryn Tucker said. "Otherwise, I am fine, physically back to normal."

"We are super close," said Kimberly Tucker of her twin. "I think we always have been close, but this definitely brought us closer. Honestly, she is the only person who understands because we are going through it together."

Copyright 2013 ABC News Radio

Wednesday
Mar142012

Hole in the Heart: Closing It No Better than Meds to Stop Strokes

iStockphoto/Thinkstock(CLEVELAND) -- As many as 26 percent of us have holes in our hearts.

This hole, found in the wall between the heart's two upper chambers, is called a patent foramen ovale, or PFO, and most of the time it isn't a cause for concern. But sometimes, a PFO can be the cause of a stroke.

In about 40 percent of strokes, patients don't have heart arrhythmias, blood clots or any other identifiable cause. In these patients, PFOs may be to blame.

The question of whether or not doctors should close PFOs in patients who have had strokes has been a hot-button issue for cardiologists and neurologists treating stroke patients for years. But a new study called the CLOSURE trial suggests that closing PFOs may be no better in preventing future strokes than treating patients with medication, a treatment route that is less costly and without the inherent risks of a medical procedure.

The study, published Wednesday in the New England Journal of Medicine, looked at 909 patients between the ages of 18 and 60 who had a PFO and had suffered a stroke without another apparent cause, called a cryptogenic stroke. About half of the patients went on medical therapy. The other half took medication and had their PFOs closed -- doctors threaded a catheter through a vein to the heart and plugged the hole with a small device called a STARFlex.

When researchers compared the two groups, they found that the risk of having another stroke was almost equal for both groups. Within two years of the procedure, 2.9 percent of the patients with closed PFOs had a stroke, compared with 3.1 percent of patients taking medication alone.

Dr. Anthony Furlan, the study's lead author and chairman of neurology at University Hospitals Case Medical Center in Cleveland, said the evidence just isn't there to support a PFO closure procedure over simply giving patients medication.

"We're not saying there are no patients who should have the hole closed, but we are saying the selection criteria have to be radically refined," he said. Ideally, a patient would be under age 45 and have a very large hole in their heart and a heart defect called an atrial septal aneurysm.

So if both treatments are equally effective, what's wrong with closing PFOs? Furlan said the procedure is costly and poses some risks for patients. According to the study, 13 patients had major vascular complications in the two years after their procedures, and 23 had atrial fibrillation, a heart arrhythmia that can be dangerous if left untreated. Only three patients taking medication alone had atrial fibrillation.

Many doctors welcomed the results of the CLOSURE trial, saying it provides real evidence about the choices doctors can give their patients.

"It has been taught and practiced for years that closing PFOs in patients with cryptogenic strokes is helpful," said Dr. Colin Barker, an assistant professor of cardiovascular medicine at the University of Texas Health Science Center. "This study shows the lack of benefit of this intervention."

"Hopefully it will significantly reduce the number of PFO closures that are being done off-label," said Dr. Amie Hsia, medical director of the Stroke Center at MedStar Washington Hospital Center in Washington, D.C.

But the study is drawing fire from other doctors who say the trial had several flaws.

Although the study included more than 900 patients, some doctors say that researchers would need about 4,000 patients to draw significant conclusions on whether or not closing PFOs is an effective way to prevent recurrent strokes. The study also included patients who had other stroke risk factors, making it difficult to tell whether the PFO alone was the cause.

Some critics also say the STARFlex device used to close PFOs in the trial is inferior to other available devices. The STARFlex device is no longer available since its manufacturer, NMT Medical, went bankrupt in 2011.

Furlan, the lead author, didn't dispute the critics who called the CLOSURE trial flawed, but he said it is so far the best information available comparing the effectiveness of PFO closure to medication.

Many doctors frequently recommend closing PFOs in patients, saying the procedure is not only safe and effective, but also gives patients peace of mind that a potential problem is solved.

Dr. Jonathan Tobis, director of interventional cardiology research at the UCLA Medical Center and an investigator in upcoming trials studying PFOs, said that relieving a patient's fears about their heart is a major factor in his decisions to close PFOs. He said the outcome of the CLOSURE trial is not enough to dissuade him from closing PFOs in some of his patients.

"I'd still consider placing one just for the anxiety-lowering effect," Tobis said.

Currently, the U.S. Food and Drug Administration has not approved any device for closing PFOs, including the STARFlex device used in the trial. But many doctors use devices off-label.

"During the 9 years it took for the results of this trial to be reported, approximately 80,000 patients have had a patent foramen ovale closed with the use of a device at an average cost of $10,000 per procedure," said Dr. Claiborne Johnston, of the Clinical and Translational Science Institute at the University of California, San Francisco, in an editorial published with the study.

Many doctors still say the results of the CLOSURE trial don't rule out closing PFOs. Doctors should assess each patient individually and determine the best option.

Two future trials are currently underway that will also compare PFO closure to medication therapy.

Copyright 2012 ABC News Radio







ABC News Radio