1550 - Stroke in a Young, Recently Pregnant Patient with Corrected Tetralogy of Fallot: A Case Report

A 20-year-old female with right middle cerebral artery (MCA) cerebral vascular accident (CVA).

Case Description: A 20-year-old female with a past medical history of pulmonary hypertension and surgically corrected Tetralogy of Fallot (ToF) presented to the emergency department with left-sided weakness, left facial droop, and left-sided gaze deviation. Stroke protocol was activated, and imaging revealed hypoattenuation in the right insula and basal ganglia, with occlusion of the right MCA M1 segment. Tenecteplase was administered, and the patient was taken for thrombectomy with successful recanalization. Notably, she reported a recent medical abortion at 7 weeks gestation, terminated less than a month prior. After stabilization, the patient was admitted to inpatient rehabilitation.

Discussions:

Stroke in young adults is uncommon, and Tetralogy of Fallot (ToF), a rare congenital heart defect, may carry lifelong cerebrovascular risks even after surgical correction. Further investigation revealed that, while the patient’s interventricular septum was surgically closed, she had a patent foramen ovale with atrial right-to-left shunting, increasing the possibility of a paradoxical embolism. Applying Virchow's triad, we postulate that her recent medical abortion may have induced a hypercoagulable state, contributing to the stroke. Additionally, her altered cardiac anatomy could have created turbulent blood flow, causing endothelial damage and subsequent thromboembolism formation. Initially, the patient required moderate to maximum assistance for daily activities, but as rehabilitation progressed, she was discharged needing only supervision or minimal assistance.


Conclusions:

Though ischemic stroke is rare in younger patients, corrected ToF increases this risk alongside other independent factors. Acute inpatient rehabilitation is critical to optimize functionality and independence in these individuals.