Dados do Trabalho

Título

Bilateral symmetrical ischemic stroke in a young patient: case report

RESUMO

CASE REPORT: A 30-year-old woman with a past record of resistant systemic arterial hypertension for 15 years, diabetes mellitus type 1 with irregular treatment, heart failure, on therapeutic anticoagulation due to right deep vein thrombosis and seronegative antiphospholipid antibody syndrome, presented to the emergency department with a sudden onset of left hemiplegia, which resolved spontaneously in less than an hour. A head CT was performed and displayed no acute alterations. The patient was discharged without being evaluated by the Neurology team. Later that same day, she exhibited a decreased level of consciousness and bilateral tonic-clonic seizures, requiring orotracheal intubation and mechanical ventilation. This time a head CT angiography was ordered and revealed an occlusion of the left middle cerebral artery and a subocclusion of the right middle cerebral artery. A new head CT confirmed bilateral symmetrical hemisphere infarction.
DISCUSSION: This is a relevant case since it depicts two rare events taking place simultaneously: a bilateral symmetrical hemisphere infarction and the occurrence of an ischemic stroke in a young patient. The incidence of stroke in young adults is low, however recent studies have shown an increase in the past years. This rise can be attributed to traditional risk factors found in ischemic strokes in older adults, such as hypertension, dyslipidemia, diabetes mellitus and obesity, but also to alcohol abuse, use of illicit drugs, thrombophilias and antiphospholipid antibody syndrome. This case illustrates a catastrophic vascular event in a young woman with multiple comorbidities that could lead both to thrombotic and to embolic events. It is important to acknowledge the occurrence of stroke in the younger population, since its dismissal could lead to tragic outcomes such as the one reported here. If the patient had received proper care when she first presented to the emergency room, with a probable transient ischemic attack, maybe the bilateral hemisphere infarction could have been avoided.
FINAL CONSIDERATIONS: It’s of great importance to control risk factors in young adults, who are in productive and reproductive age, in order to avoid ischemic events and their disabling sequels that affect not only the patients but family and society as well.

Palavras Chave

ischemic stroke; young adult; risk factors