# Unrecognized Atrial Septal Defect Presenting with Postoperative Occipital Infarction

## TL;DR

A woman's post-surgery stroke was linked to an undetected heart defect, showing how hidden heart issues can cause strokes.

## Contribution

This case highlights the importance of multimodal imaging in diagnosing occult atrial septal defects as a cause of cryptogenic stroke.

## Key findings

- A 4.6 mm ostium secundum atrial septal defect was identified as the source of embolic stroke.
- Percutaneous closure of the defect resolved the shunt and prevented further complications.
- Multimodal imaging confirmed the presence of an interatrial shunt and guided treatment.

## Abstract

A 49-year-old woman developed acute homonymous hemianopia three days after elective surgery. Neuroimaging confirmed an embolic right occipital infarction. Transthoracic echocardiography demonstrated early bubble passage, and transesophageal imaging identified a 4.6 mm ostium secundum atrial septal defect. The defect was successfully closed percutaneously with complete shunt resolution. This case emphasizes the value of targeted multimodality imaging in uncovering occult interatrial shunts and highlights presumed paradoxical embolism as a potential mechanism of postoperative or cryptogenic stroke.