London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 355 140 Interesting and challenging cases Cardioembolic Stroke due to Hypercoagulability in a Case of Behçet’s Disease F. Delen1, Z. Kuzu2, M.H. Sorgun3, C. Togay Işıkay4 Ankara University Faculty of Medicine Department of Neurology, Ankara, TURKEY1, Ankara University Faculty of Medicine Department of Neurology, Ankara, TURKEY2, Ankara University Faculty of Medicine Department of Neurology, Ankara, TURKEY3, Ankara University Faculty of Medicine Department of Neurology, Ankara, TURKEY4 Introduction: Behçet’s disease (BD) is a chronic, inflammatory, multisystemic disorder of unknown origin. BD may affect the nervous system in 5-30% of the patients. Parenchymal involvement and cerebral venous thrombosis are two common manifestations of Neuro-Behçet disease (NBD). We present a case of multiple cerebral infarcts of cardioembolic origin in BD. Case Report: A 22-year-old man was admitted to our stroke unit with acute onset hypoesthesia on the left arm and slurred speech. According to his medical history, he had attacks of hyperthermia, abdominal pain and lack of appetite lasting a few days once a month for four years. The physical examination re-vealed high fever, oral and genital ulcers and splenomegaly. The neurological examination revealed right facial paralysis. Diffusion weighted images of the brain demonstrated multiple acute infarcts in the right frontal, parietal, temporal and occipital regions and right nucleus caudatus. The ultra-sound of the carotid and vertebral arteries, and angiography of the brain were unremarkable. Labo-ratory tests showed a erythrocyte sedimentation rate of 120/h, C-reactive protein of 180, d-dimer of 1556, and hemoglobin of 8.2g/dl. Electrocardiography and chest x-ray were normal. Immunological markers, serologic tests for infectious diseases and repeated cultures of blood and urine were nega-tive. Genetic tests revealed homozygous MTHFR gene mutation. Transesophageal echocardiogra-phy and cardiac MRI demonstrated thrombus in the left ventricular apex. CT angiyography of tho-rax was consistent with chronic pulmonary thromboembolism. Low molecular weight heparin, pulse steroid and cyclophosphamide treatment were started with the diagnosis of BD, pulmonary throm-boembolism and multiple cerebral infarcts due to cardiac thrombus. Conclusion: Ischemic stroke due to BD has been rarely reported and the main mechanism of stroke was cerebral vasculitis. Our case with cardiac thrombus and homozygous MTHFR gene mutation represents an uncommon form of ischemic stroke in BD. 141 Interesting and challenging cases GLOBAL TRANSIENT AMNESIA AND MILIMETRIC PUNCTIFORM DIFFUSION WEIGHTED IMAGING LESION IN LEFT HIPPOCAMPUS, CAN IT BE CONSIDERED AN STRATEGIC STROKE?. C. de la Cruz Cosme1, C. Del Río Oliva2, A. Mármol Prados3, E. Vila Herrero4 Hospital Quirón Málaga, Málaga, SPAIN1, Hospital Quirón Málaga, Málaga, SPAIN2, Hospital Quirón Málaga, Málaga, SPAIN3, Hospital Quirón Málaga, Málaga, SPAIN4 BACKGROUND. Global transient amnesia (GTA) is a syndrome of acute onset of transient glob-al anterograde amnesia, with a variable degree of impairment of retrograde memory, which is not associated with any other major neurologic signs or symptoms. Etiology is unknown, and transient ischaemia has been considered to be a possibility. Some authors have described high signal intensity in hippocampus in DWI (diffusion weighted imaging) of magnetic resonance imaging (MRI) mainly when done after the first 48 hours, and different MRI patterns can help to presume different origins (ischemic, epileptic, metabolic, inflammatory or idiopathic). METHODS. A 66 years old male suf-fered a GTA syndrome. Physical examination was completely normal, except short term memory impairment that lasted about 12 hours. Diagnostic workup was performed including analysis, brain CT (in hyper acute stage) and MRI (72 hours after the episode. RESULTS. A punctiform hyperin-tense lesion was detected on left hippocampal gyrus in DWI, what drove to radiological diagnosis of acute ischaemic infarct. The only other abnormality in etiological stroke studies was a positive result for antinuclear antibodies, with no clinical criteria for lupus. CONCLUSIONS. This case contributes to support the hypothesis of hippocampal dysfunction in GTA, but generates discussion about vascular origin, as no consistent arterial risk factors had been reported, lesion appeared when patient had become asymptomatic and the present MRI pattern tends to be consider typical for id-iopathic TGA more than strategic stroke in recent reviews, what made us to change diagnosis from “strategic acute ischemic stroke with GTA”, what had been suggested by radiologists to “GTA with left punctate DWI lesion in the left hippocampal gyrus”, whose prognostic implications are very dif-ferent. Further reports are needed to know origin of DWI lesions in GTA.
Karger_ESC London_2013
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