RoPE Score (PFO in Cryptogenic Stroke)

About one adult in four has a patent foramen ovale, so finding one after a cryptogenic stroke does not by itself make it the culprit. RoPE separates the two situations by asking how well the patient fits the profile of paradoxical embolism: young, free of the vascular risk factors that produce small-vessel and atherosclerotic strokes, and with a superficial cortical infarct rather than a deep lacunar one. Each of those raises the score, and a higher score corresponds to a higher estimated PFO-attributable fraction — the share of PFOs at that score judged pathogenic rather than incidental. The counterintuitive half of the result matters as much as the score: patients whose PFO is most likely to be causal have the LOWEST estimated recurrence risk on medical therapy, because a scored-out patient has few competing mechanisms, while a low score signals a vascular-risk-factor burden that keeps generating strokes. The imaging item is the one a radiologist supplies, and it is worth stating plainly in the report — "cortical infarct" or "deep/lacunar infarct" — because the stroke team cannot score it from a list of structures.