An Unusual Case of Thalamic Stroke in a Young Adult With Patent Foramen Ovale and Finasteride Use

Symptomatic cerebral infarcts with cryptogenic ischemic stroke pose diagnostic challenges due to unknown etiology. Notably, up to half of young individuals with cryptogenic stroke exhibit patent foramen ovale (PFO), while finasteride, which is used for male pattern baldness, elevates testosterone le...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2024-05, Vol.16 (5), p.e60300
Main Authors: Gaddameedi, Sai Rakshith, Khan, Mahrukh A, Arty, Fnu, Bandari, Vandana, Vangala, Anoohya, Panchal, Pratik, Shah, Shazia M
Format: Article
Language:English
Subjects:
Aneurysms
Baldness
Blood clots
Cardiology
Case reports
Enzymes
Etiology
Hair
Heart attacks
Internal Medicine
Ischemia
Magnetic resonance imaging
Males
Medical equipment
Medical imaging
Neurology
Patients
Pharmaceuticals
Risk factors
Stroke
Testosterone
Thrombosis
Tomography
Young adults
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Summary:Symptomatic cerebral infarcts with cryptogenic ischemic stroke pose diagnostic challenges due to unknown etiology. Notably, up to half of young individuals with cryptogenic stroke exhibit patent foramen ovale (PFO), while finasteride, which is used for male pattern baldness, elevates testosterone levels, potentially increasing the risk of thrombosis. Here, we present a case of thalamic infarction in a 21-year-old male devoid of cerebrovascular risk factors but with PFO and finasteride use. The patient presented with short-term memory issues, otherwise lacking medical history or substance use. Examination revealed neurological deficits, with imaging indicating a left thalamic infarct. Subsequent investigations identified PFO, prompting referral for closure, yielding symptomatic improvement. Furthermore, discontinuation of finasteride was advised due to its thrombotic association. Finasteride's inhibition of 5-alpha reductase 2 increases testosterone conversion to estrogen, potentially promoting thrombosis. Finasteride use can cause thrombotic events, emphasizing its risk. In conclusion, young embolic stroke patients warrant PFO evaluation alongside hypercoagulable workup, with closure benefiting those under the age of 55. Additionally, discontinuing finasteride may mitigate thrombosis risk.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.60300