Recurrent stroke in a patient with vitamin B12 deficiency and MTHFR mutation

We report an unusual case of recurrent stroke in a patient with vitamin B12 deficiency who was also homozygous for the methylene tetrahydrofolate reductase (MTHFR) gene mutation. The patient was a 35-year-old male vegetarian with no known medical history who initially presented with global aphasia, slurred speech, right facial weakness, and right-sided hemiplegia and was found to have a stroke (NIH Stroke Scale score of 25). At that time a CT scan of the head ruled out intracranial hemorrhage and a CT angiogram of the head and neck was done. The patient was found to have occlusion of the M1 segment of the left middle cerebral artery. Because he was within the time frame for thrombolytics, systemic thrombolysis with alteplase was given without improvement. He therefore underwent a cerebral angiogram that demonstrated occlusion of the M1 segment of the left middle cerebral artery and very poor leptomeningeal collaterals from the left anterior and posterior cerebral artery territories (figure 1). He underwent mechanical thrombectomy of the left middle cerebral artery thrombus with Penumbra aspiration device (Penumbra Inc., Alameda, CA) and SOLITAIRE stentriever (Covidien, Irvine, CA) with complete recanalization of the occluded segment (figure 2). He had a remarkable early recovery as the hemiplegia resolved. During the hospital course he was placed on a statin and low-dose aspirin and was later discharged to a rehabilitation unit for treatment of his right-sided hemiparesis and...
Source: Neurology Clinical Practice - Category: Neurology Authors: Tags: Stroke in young adults, Stroke prevention, Hematologic, All Cerebrovascular disease/Stroke Case Source Type: research