Background Cryptogenic stroke (CS) represent a diagnostic challenge.Prior studies have shown an association between the presence of a patent foramen ovale (PFO) and CS in patients < 55 years old.In addition,protruding atheromas in the ascending aorta and aortic arch are an independent risk factor for ischemic stroke in patients > 55 years old.We studied the association of PFO and atheromas in the ascending aorta and aortic arch with CS in these two groups of patients.Methods Transesophageal echocardiography (TEE) in 229 consecutive patients evaluated for CS were compared to TEEs in 314 patients evaluated for valve disease or endocarditis with no history of stroke (control group).The prevalence of PFO,complex atheromas in the ascending and aortic arch (protruding atheroma ≥ 4 mm thickness,presence of mobile components or presence of ≥ 2 mm surface ulceration) was determined in all patients and compared between the between CS and control patients in both age groups.