Cryptogenic multi-infarcts and cortico-subcortical dementia in a young adult

• Type: Article in International Scientific Journal
• Date: 2007

Authors

Joana Guimaraes (Author) FMUP; Fonseca, R (Author) Other; Elsa Azevedo (Author) FMUP

Journal

Title: Journal of the Neurological Sciences

Vol. 257 No. 1

Pages: 255-257

ISSN: 0022-510X

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 0 Citations

Scopus - 0 Citations

Pubmed / Medline

Scientific classification

CORDIS: Health sciences > Neuroscience > Neurology

Other information

Authenticus ID: P-004-9C5

DOI: 10.1016/j.jns.2007.01.023

Abstract (EN): Introduction: Etiology of stroke and dementia in young adults are challenging clinical problems, and these diseases often have devastating consequences. We present a case where a final etiologic diagnosis is not possible, in spite of an exhaustive study. Case Report: A 34-year-old man presented with a 5-year history of transient neurological deficits. Examination disclosed a cortico-subcortical dementia, but no other deficits. Laboratory evaluation was unremarkable, including the basic vascular study, homocystein, immunologic study, ACE, serology for Lyme, syphilis and HIV, tests for mitochondrial cytopathy, CADASIL and Fabry's disease, and CSF study. Prothrombotic study was normal except for a heterozygous mutation for factor V Leiden and for methylene tetrahydrofolate reductase. Cardiac exams (electrocardiogram, transesophagic echocardiography and 24 h-ECG) were normal. Cervical and transcranial duplex ultrasound and magnetic resonance angiography (MRA)-were normal, except for a hypoplasic right vertebral artery. Brain magnetic resonance imaging revealed corticosubcortical atrophy and multiple infarcts. The patient was prescribed antiplatelet and statin therapy, and is presently clinically stabilized after 3 years of follow-up, scoring 2 in modified Rankin scale. Discussion: Differential diagnosis of young onset vascular dementia is wide, including a number of rare sporadic and hereditary diseases. Although our case has a heterozygotic mutation for factor V Leiden, this might not explain the whole clinical picture; furthermore, there is no history of other vascular events, as venous thrombosis. An extensive investigation did not lead to a final etiological diagnosis. Nevertheless, even in these cases prevention with antiplatelet and statin might lead to clinical stabilization.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 3