In the economy class syndrome (ECS) the patient presents a deep venous 
thrombosis (DVT) with or without pulmonary thromboembolism (PTE) during or after 
a long trip as a result of prolonged immobilization. Economy class stroke 
syndrome is an infrequent ECS variant in which ischemic stroke is associated 
with a patent foramen ovale (PFO). Few cases have been published in the 
literature to date. We present a patient who suffered a PTE and an ischemic 
stroke immediately after a transoceanic flight. A 36-year-old woman with no 
significant medical or familial history flew economy class from Lima, Peru, to 
Madrid, Spain. On disembarkation she presented sudden dyspnea and a depressed 
level of consciousness, global aphasia, and right hemiparesis. A pulmonary 
scintigraphy showed a PTE and a cranial MRI revealed an ischemic infarct in the 
left middle cerebral artery territory. We simultaneously performed a 
transesophageal echocardiography and a transcranial Doppler and observed a 
massive right-to-left shunt through a PFO. The patient was a heterozygous 
carrier of the C46T mutation of coagulation factor XII. The appearance of a 
stroke following a long trip is suggestive of paradoxical embolism through a 
PFO, mainly if it is associated with a DVT and/or a PTE. The cause of the 
initial event, the DVT, could be a prothrombotic state.