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Objectives. The aim was to estimate the recurrence rate and to define subgroups at increased risk for recurrent cerebral ischaemia in patients with patent foramen ovale (PFO) and so called cryptogenic stroke due to paradoxical embolism. Methods. Patent foramen ovale was diagnosed in 318 patients with otherwise unexplained ischaemic stroke or transient ischaemic attack (TIA). One hundred and fifty nine were treated medically (oral anticoagulation 79, platelet inhibitors 80) and represent the study population. The remaining 159 patients underwent endovascular or surgical closure of the PFO and are not part of this study. Results. Mean age was 50.7 (SD 13.5) years. The event leading to the diagnosis of PFO was a TIA in 38 patients (23.9%), an ischaemic stroke in 119 (74.8%), and an amaurosis fugax in two patients (1.3%). Forty four patients (27.7%) had experienced multiple cerebrovascular ischaemic events before the diagnosis of the PFO. During mean follow up of 29 (SD 23) months 21 patients (13.4%) had a recurrent cerebrovascular event (seven strokes and 14 TIAs). The average annual rate of recurrent strokes was 1.8% and that of recurrent strokes or TIAs was 5.5%. When patients with PFO with multiple cerebrovascular events before the diagnosis of the PFO were analyzed separately, the average annual rates of recurrent cerebral ischaemia were 3.6% for recurrent strokes and 9.9% for recurrent strokes or TIAs. These rates were significantly higher than in patients with first ever stroke or TIA (p=0.02). Conclusions. The study confirms a risk of stroke recurrence that is similar to the rates of previously published series of patients with PFO and cryptogenic strokes. Patients with more than one previous event were at increased risk of recurrent cerebral ischaemia.T he cause of ischaemic stroke in young patients is often not found despite systematic investigations. Such strokes are classified as cryptogenic. In patients with cryptogenic strokes patent foramen ovale (PFO) can be detected in more than 50%, whereas its prevalence in the general population is at least 25%.1-3 Therefore, PFO is likely associated with cryptogenic stroke. The presumed mechanism is paradoxical embolism of venous thrombotic material across the atrial right to left shunt. A thrombus crossing the PFO and subsequently embolyzing to the brain has been rarely detected.4 5 However, because direct evidence for paradoxical embolisation is rare in the individual clinical situation the potential role of the PFO in stroke is still a matter of debate. Earlier studies have suggested that a patent foramen ovale is an incidental finding in patients with cryptogenic strokes and does not represent a risk factor for cerebral ischaemia.6 7 On the other hand, later studies and a meta-analysis support PFO as a risk factor for stroke, and more recent investigations also found a strong association between the morphological characteristics of the PFO and the risk of embolic cerebrovascular events. [8][9][10] The coincidence of an atrial septal aneurysm (ASA) seems to i...

Seventy-eight British soldiers stationed in the Eastern Sovereign Base Area (ESBA) in Cyprus contracted Q fever in the period December 1974 to June 1975. Pneumonia developed in 59% of cases. Of 31 patients tested, 81% had biochemical evidence of hepatitis although only one became clinically jaundiced. Three patients (4%) suffered pericarditis. Treatment with tetracycline had no apparent effect on the course of the disease. Investigation revealed an abortion epidemic involving 21 mixed flocks of sheep and goats in the south-eastern coastal region. 11 of the flocks grazed in and around the ESBA. A serological survey of 10 affected flocks, and evidence collected from previous years, indicated that the abortion epidemic was the result of infection with Coxiella burneti. Infection in the humans was almost certainly acquired by inhalation of dust from brush contaminated with rickettsial parturition products of the aborting flocks. A human serological survey revealed a number of cases of subclinical Q fever in a susceptivle military population, and an asymptomatic epidemic in a largely immune local position.

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