Background: Paradoxical embolism via a patent foramen ovale (PFO) is a rare event in the puerperium as a cause of stroke. Case: We report a 21-year-old, G4P3A1 woman with the symptoms of convulsion, stroke and unconsciousness 1 week after cesarean delivery. An infarction was detected in both frontal lobes, and echocardiography and MRI confirmed the PFO. Her follow-up course with low-molecular weight heparin and then warfarin for 6 months was uneventful. Conclusion: Patients with an unexplained arterial event should be screened for PFO and possible paradoxical embolism. Copyright (c) 2008 S. Karger AG, Basel.