THROMBOTIC ISCHEMIC STROKE IN A CASE WITH MODERATE HYPERHOMOCYSTEINEMIA
Abstract:
Increased concentration of homocysteine is a risk factor for stroke, peripheral vascular disease, myocardial infarction, and venous thromboembolism. It seems that hyperhomocysteinemia affects not only the blood coagulation system, but also the vascular wall structure. MTHFR gene encodes a co-substrate for homocysteine remethylation to methionine, but it is also involved in transsulfuration to cystathionine. We present the case of a 42-year-old man hospitalized for treatment and functional rehabilitation in Medical Rehabilitation Clinical Hospital Băile Felix, Romania, after ischemic stroke. The patient with unremarkable anamnesis, negative family history, no known diagnosis of homocystinuria developed an acute cerebrovascular ischemic accident. MRI described an ischemic vascular lesion of the left cerebellar hemisphere with edema, herniation phenomena through foramen magnum and supratentorial and amputation of the fourth ventricle. Ultrasonography of the heart and precerebral arteries revealed normal aspects. The most significant laboratory finding was moderate hyperhomocysteinemia. Molecular analysis revealed the presence of a heterozygous MTHFR C677T mutation and the absence of A1298C mutation. After drug therapy, he was admitted in our clinic at about one month after the vascular accident, having only coordination problems. Rehabilitation treatment was complex and involved coordination of several team members, with the following main objectives: coordination and balance in physical activities, through stimulation exercises specific for occupational therapy and kinetotherapy. He showed significant improvement after three weeks of intensive treatment. Prompt response to the rehabilitation programme in this case is another argument for early, individualized treatment, which continues at home, over a long period of time.
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