A report of recurrent ischemic stroke caused by premature atherosclerotic intracranial stenosis in a 26-year-old man with underlying cirrhosis, hypertension in the young and chronic kidney disease

Authors

  • Chaiwat Klinhom-on Primary Stroke Center & Neurology Unit Phramongkutklao Hospital
  • Chesda Udommongkol Primary Stroke Center & Neurology Unit Phramongkutklao Hospital

Keywords:

intracranial stenosis, recurrent stroke, premature atherosclerosis,, moyamoya syndrome

Abstract

The authors reported a 26-year-old Thai male military officer presenting with recurrent ischemic stroke. MRI showed multiple infarcts in bilateral subcortical areas in MCA territories and asymptomatic brain stem & middle cerebellar peduncle infarction. MRA revealed bilateral terminal ICA, proximal M1 MCA & A1 ACA stenosis whereas transcranial colour-coded sonography (TCCS) showed non-stenotic flow in all insonated arteries indicating normal hemodynamic circulation in pathological vessels. Co-morbidities were hypertension in young adult, chronic kidney disease and cirrhosis with occasional upper gastrointestinal hemorrhage exacerbating or worsening intracranial disease. After possible causes of stroke in young adults were investigated and showed negative, the most likely diagnosis was premature atherosclerotic intracranial stenosis complicated with multiple serious systemic diseases mimicking moyamoya syndrome which was not caused by moyamoya disease.

References

Scott RM, Edward R. Smith ER. Moyamoya Disease and Moyamoya Syndrome. New Eng J Med 2009;360:1226-37

Turan TN, Derdeyn CP, Fiorella D, Chimowitz MI. Treatment of Atherosclerotic Intracranial Arterial Stenosis. Stroke. 2009;40:2257-61

Arenillas JF. Intracranial Atherosclerosis: Current Concepts. Stroke 2011; 42: S20-S23

Suri MF, Johnston SC. Epidemiology of intracranial stenosis. Neuroimage 2009;19 Suppl1:11S-6S

Williams CL, Hayman LL, Daniels SR, et al. Cardiovascular Health in Childhood: a statement for health professionals from the committee on atherosclerosis, hypertension, and obesity in the young (AHOY) of the council on cardiovascular disease in the young, AHA. Circulation 2002;106:143-60
vol15No1

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Published

2019-02-13

How to Cite

1.
Klinhom-on C, Udommongkol C. A report of recurrent ischemic stroke caused by premature atherosclerotic intracranial stenosis in a 26-year-old man with underlying cirrhosis, hypertension in the young and chronic kidney disease. J Thai Stroke Soc [Internet]. 2019 Feb. 13 [cited 2024 Jul. 27];15(1):49-55. Available from: https://he01.tci-thaijo.org/index.php/jtss/article/view/172119

Issue

Vol. 15 No. 1 (2016): January - April

Section

Case Report

License

ข้อความภายในบทความที่ตีพิมพ์ในวารสารสมาคมโรคหลอดเลือดสมองไทยเล่มนี้ ตลอดจนความรับผิดชอบด้านเนื้อหาและการตรวจร่างบทความเป็นของผู้นิพนธ์ ไม่เกี่ยวข้องกับกองบรรณาธิการแต่อย่างใด การนำเนื้อหา ข้อความหรือข้อคิดเห็นของบทความไปเผยแพร่ ต้องได้รับอนุญาตจากกองบรรณาธิการอย่างเป็นลายลักษณ์อักษร ผลงานที่ได้รับการตีพิมพ์ในวารสารเล่มนี้ถือเป็นลิขสิทธิ์ของวารสาร