Abstract
We report a case of cerebral thrombosis associated with left middle cerebral artery stenosis and hyperhomocysteinemia. A 48-year-old man, without underlying previous illness, was admitted to our hospital presenting repeated episodes of a few minutes of right hemiparesis and dysesthesia. MRI FLAIR and diffusion-weighted imaging revealed a high intensity signal in the left posterior putamen. MRA and cerebral angiography showed left middle cerebral artery stenosis. He was diagnosed as having cerebral thrombosis and treated with Argatroban, edaravone, aspirin, and cilostazol, resulting in recovery from symptoms within five days after the initiation of treatment. Hyperhomocysteinemia and vitamin B6 and folic acid deficiencies were detected using a series of blood tests. His methylenetetrahydrofolate reductase 677 polymorphism was the TT genotype. Recently, two meta-analyses reported that lowering homocysteine using folic acid and vitamins B6 and B12 reduced the risk of stroke.
In cerebral infarct cases without known causes, we need to assess the blood homocysteine level and may consider prescribing folic acid and vitamins B6 and B12 in addition to antiplatelet treatment.
