Ischemic stroke during sexual intercourse - A report of 4 cases in persons with patent Foramen ovale

Background: The association between patent foramen ovale (PFO) and stroke risk in young adults is controversial and poorly understood. Paradoxical embolization through a PFO represents a possible mechanism by which PFO might predispose to stroke. Objective: To describe 4 patients with PFO who experienced the onset of ischemic stroke during sexual intercourse. Design: Case series. Setting: Tertiary referral stroke clinic. Patients: Consecutive patients experiencing stroke during intercourse. Results: All 4 patients were found to have PFO. Despite a thorough evaluation, no other etiology for stroke was identified. Conclusion: We suggest that paradoxical embolization through a PFO due to elevated intrathoracic pressure during sexual activity could be a potential mechanism for stroke in these patients.