The recent technical development of echocardiography, especially transesophageal echocardiography, made the diagnosis of patent foramen ovale in adult life possible. The defect predisposes the patient to paradoxical embolism and is therefore of great clinical significance. There is a close association between patent foramen ovale and ischemic stroke in both younger and older patients. Patent foramen ovale is found significantly more frequently in patients who have suffered ischemic stroke than in healthy individuals. The definite management of patients with patent foramen ovale and ischemic stroke still remains a therapeutic challenge. The therapeutic options include long-term anticoagulant or antiplatelet therapy, and more invasive procedures, such as surgical closure or transcatheter closure of the defect.