May-Thurner Syndrome and Patent Foramen Ovale: A Rare Etiology of Cryptogenic Stroke

Patients who present with stroke or transient ischemic attacks (TIA) in the setting of patent foramen ovale (PFO) mandate investigation of the lower extremities and pelvis in order to determine a possible source of thromboembolic disease. Imaging studies including Doppler ultrasound of the extremities may not be sufficient to diagnose the presence of anatomic variants that predispose patients to thrombus formation. May-Thurner syndrome (MTS) is characterized by extrinsic compression of the common iliac veins or inferior vena cava which leads to chronic physiologic changes within the vasculature. This condition increases risk of venous occlusion, diminution of venous flow, and most significantly, formation of thrombi. In this case report, we present a young Hispanic female diagnosed with ischemic cerebral vascular accident (CVA) secondary to thromboembolism in the setting of May-Thurner syndrome and a PFO, a rare etiology of cryptogenic CVA.