EMBOLIC STROKE IN A CADASIL PATIENT
Yu-Jyun Hong, 1 , Li-Ming Lien, ,
1 Shin Kong Wu Huo-Shih Memorial Hospital
Li-Ming Lien ,
Shin Kong Wu Huo-Shih Memorial Hospital
A 47-year-old CADASIL patient presented to our emergency department with an acute onset of left hemiparesis. MRI of the brain demonstrated multiple small cortical infarcts in both cerebral hemispheres. Carotid ultrasonography was normal. The detailed coagulation profile and autoimmune serology were unremarkable. Transthoracic and transesophageal echocardiography revealed normal valves and no evidence of intracardiac thrombi or other cardiac anomalies. No arrhythmias were detected on the long-term ECG monitoring. The work-up for malignancy including tumor markers and whole-body PET scan showed results within normal limits. Despite extensive diagnostic work-up, no embolic sources were identified. The patient was eventually diagnosed with embolic stroke of undetermined source.
CADASIL is an inherited small-vessel disease, with one of its typical features being subcortical lacunar lesions localizing within the centrum semiovale, thalamus, basal ganglia, and pons. In summary, we have described an unusual case of CADASIL presenting with multiple acute cortical infarcts. No convincing evidence of an embolic source was disclosed in our investigations.