Dados do Trabalho

Título

Multiple ischemic strokes due to Adult-onset Still’s disease: Case report

RESUMO

Case presentation: A 44 year old Woman reports that in februrary os 2022 presented sudden change of visual field with a homonymous right hemianopia. She had previous diagnosis of schizophrenia, a stroke in 2019, and Adult-onset still’s disease (AOSD) diagnosed in 2020. In the hospital admission, the CT scan revealed a recent onset ischemic stroke in the left thalamus, occiptotemporal gyrus and cuneo, besides a stroke sequel on the right frontal, temporal, parietal, insula, adjacent to the lateral fissure. The head and neck angio tomography revealed a oclusion of the comunicating segment of the right internal carotid as well as the A1 segment of the right anterior cerebral artery, the right middle cerebral artery and the P2 segment of the left posterior cerebral artery (PCA). Cardiac investigation was done with electrocardiogram, 24 hour holter, transthoracic and transesophageal echocardiogram resulting normal. It was then performed the cerebral arteriography resulting intracranial vascular oclusive disease in two distinct vascular territories (a cronic feature occlusion on the top of the right ICA and a subocclusion on the P2 segment of the left PCA), possibly due to an inflamatory component. Pulse therapy was then performed with 1 g per day of methylprednisolone for 5 days, and a posterior introduction of prednisolone 60 mg per day.

Discussion: AOSD is an inflamatory disorder, characterized by daily fever, arthritis and evanescent rash that occurs in patients older than 16 years old. The etiology is unknown with an annual incidence of approximaly 0,16 cases per 100.000 people. The AOSD is a diagnosis of exclusion and can be done on base on the clinical features and the typical laboratorial findings following the yamaguchi diagnostic criteria. Ischemic istroke is a rare complication of this disease, and the explanation for this event is the vasculitis pathophysiology. The corticosteroids are the first line druggs for treatment.

Final considerations: We reported an uncommon case of a young 44 years old woman with previous diagnose of AOSD, that had a stroke in different territories, with involvment of the anterior and posterior circulation, visualized by the head and neck angio tomography and arteriography corroborating with typical finding of vasculitis. Thus, it’s importante to be alert that one of the possible complications of the AOSD is the occurrence of stroke events due to vasculitis inflamatory process.

Palavras Chave

Adult Onset Still’s Disease; Multiple strokes; Stroke; Vasculitis; Young adult;