A youngJapanese female with a possible history of seizure presents with 3 days of R-sided facial droop and weakness. Initial CT head was negative; CTA was obtained for dissection but this was also normal. MRI ultimately revealed an ischemic infarct in the left putamen, consistent with the patient’s presenting symptoms. We discussed an approach to stroke in the young patient, including the high prevalence of dissection in this group and the importance of obtaining a CTA with initial imaging.
1. When is a hypercoagulable workup appropriate in ischemic stroke?
There is really no good data to guide this, and all of the information I could find was based on expert opinion. Their recommendation is to send the workup if a) echo + vascular studies show no clear etiology in a young patient without other risk factors (such as ours), b) family or personal history of other systemic thromboses, or c) other clinical features of SLE or APLS
2. Causes of venous AND arterial thrombosis (as opposed to the long list of causes of only venous thromboses, which often do not require further workup)
-TTP, HUS, DIC
-Causes of hyperviscosity: PCV, Waldenstrom’s Macrogloulinemia, SCD
Paradoxical emboli (VTE that pass through R->L cardiac shunt)