Abstract
Congenital plasminogen abnormality characterized by diminished fibrinolytic activity is assumed to be a causative factor of a thrombotic tendency, but has rarely been proposed as a cause of cerebral infarction. This report deals with familial cases of congenital plasminogen abnormality associated with cerebral infarction as a first symptom. A 49-year-old man presented with sudden onset right hemianopsia. MR of the brain demonstrated an acute hyperintense lesion in the left occipital lobe and left temporal base, while stenosis of the left posterior cerebral artery was detected on MRA. The blood laboratory values including those of coagulation studies showed a reduction in plasminogen activity but no other abnormal data. Transesophageal echocardiography (TEE) revealed patent foramen ovale (PFO). The patient's 20-year-old son also complained of hemianopsia, but he was unsure as to when it had started. MR demonstrated an old cerebral infarction of the left occipital lobe. Apart from a reduced plasminogen activity, no other abnormal laboratory values were found. TEE also revealed PFO. The plasminogen abnormality and paradoxical embolism may have caused the cerebral infarction in these two familial cases, so that congenital plasminogen abnormalities could constitute a risk factor for juvenile cerebrovascular disease.
