Platypnea orthodeoxia syndrome associated with patent foramen ovale incidentally diagnosed in a patient with ventriculitis/bacterial meningitis

• Published in: Japanese Journal of Stroke Vol. 36; no. 2; pp. 71 - 75
• Main Authors: Haga, Tomoaki, Muramoto, Emiko
• Format: Journal Article
• Language: Japanese
• Published: The Japan Stroke Society 2014
• Subjects: bacterial meningitis; paradoxical brain embolism; patent foramen ovale; platypnea orthodeoxia syndrome; ventriculis
• ISSN: 0912-0726; 1883-1923
• DOI: 10.3995/jstroke.36.71

The patient was a 78-year-old male admitted for ventriculitis/bacterial meningitis. Cyanosis was noted in a sitting position. SPO2 was maintained at 90% or higher in recumbency, but it decreased to 60% in a sitting position, although no dyspnea was noted. On thorough examination, the heart was excluded and the foramen ovale was opened by excessively extending and dilating the ascending aorta. When exclusion by the ascending aorta was strengthened in a sitting position, patency of the foramen ovale was promoted, which increased the right-to-left shunt and decreased SPO2. Based on these findings, the patient was diagnosed with patent foramen ovale-associated platypnea orthodeoxia syndrome (POS), and the patent foramen ovale was suspected of being the route of infection of ventriculitis/bacterial meningitis. Posterior cerebral arterial embolism developed when he was 73 years old, and paradoxical cerebral embolism involving the patent foramen ovale was suspected. We report a case of patent foramen ovale-associated POS diagnosed in a patient admitted for ventriculitis/bacterial meningitis.