London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 379 182 Interesting and challenging cases Stroke in Young Patient with Multiple Gene Mutations Z. OZOZEN AYAS1, A. BOLUK2 SAKARYA UNIVERSITY EDUCATION AND RESEARCH HOSPITAL NEUROLOGY DEPARTMENT, SAKARYA, TURKEY1, SAKARYA UNIVERSITY EDUCATION AND RE-SEARCH HOSPITAL NEUROLOGY DEPARTMENT, SAKARYA, TURKEY2 Background: Thrombotic gene mutation is one of the important hereditary reason etiology of cere-brovascular disease in young adults. Sometimes they can be detected alone, rarely multiple gene mutations can be determinated in etiological investigations. Young patient who presented with acute ischemic cerebrovascular disease with heterozigot mutation of Factor V Leiden, methylenetetrahy-drofolate reductase (MTHFR) C677T and MTHFR A1298C is reported. Case Report: A 32 year-old woman who had no significant medical history, presented at the hospital with minimal left hemiparesia and hemiparestesia. She was a smoker for fifteen years. Her father and aunt had mi-nor stroke disease. Her neurological examination included right hemiparesia (5-/5) and hemiparest-esia. Her biochemical blood results were as follows decreased vitamine B12 144pg/mL(187-883) and folic acid 2,7ng/mL(3.1-20.5) level and electocardiography was normal sinüs rhythm. Com-puted tomography (CT) of the brain was normal. Her MRI showed right capsula interna acute in-farct lesion. She treated with low molecule weight heparine. Echocardiography, Doppler ultrasound imaging of the carotid and vertebral arteries were normal. Her coagulation laboratory results showed moderately high homocysteine level 20 umol/L (5-15) and genetic tests revealed heterozigot mu-tation of Factor V Leiden, MTHFR C677T and MTHFR A1298C. The patient’s symptoms were im-proved after six days of ischemic stroke therapy. Conclusion: Multiple gene mutations, hyperhomocysteinemia and smoke can facilitate thrombosis in this case. We emphasize that multiple risk factors can be detected etiological investigations in young patient with stroke especially multiple gene mutation disorders. 183 Interesting and challenging cases Stroke mimics in patient with carbon monoxide intoxication J. Haring1, G. Krastev2, M. Mako3 Department of Neurology, Faculty Hospital Trnava, Trnava, SLOVAKIA1, Department of Neu-rology, Faculty Hospital Trnava, Trnava, SLOVAKIA2, Department of Neurology, Faculty Hospital Trnava, Trnava, SLOVAKIA3 Carbon monoxide (CO) is a highly toxic gas produced by incomplete combustion of hydrocarbons and is a relatively common cause of human intoxication. Human toxicity is often overlooked be-cause CO is tasteless and odorless and its clinical symptoms and signs are non specific. Hypoxic brain damage predominates in the cerebral cortex, cerebral white matter and basal ganglia, espe-cially in the globus pallidus. We report a patient who was admitted to the ICU at the Department of Neurology with the history of sudden onset of unconsciousness, myoclonic jerks of the upper extremities, initialy reported as the bilateral thalamic infarction with negative CT scans. As it is known, the clinical signs of bilateral thalamic infarction often involve disorder of consciousness, memory dysfunctions, various types of vertical gaze palsy and psychic changes, especially when a paramedian region is affected. The main cause of this type of stroke is small artery disease. In our patient the detailed history together with supportive MRI finding of haemorrhagic lesions in globus pallidum and clinical suspicion of the carbon monoxide exposition was essential in determinig the right diagnosis. The patient developed epilepsy as a cosequence of CO intoxication and is further observed due to potential late consequences of CO poisoning. Keywords: carbon monoxide, stroke, globus pallidum
Karger_ESC London_2013
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