ABSTRACT
A 69-year-old man who had essential thrombocythemia, for which he was taking no medications, suddenly developed aphasia and right hemiplegia and was admitted to the hospital. He was thought to have had an embolic stroke and was initially treated with warfarin. Although the international normalized ratio was in the therapeutic range, he had 3 additional ischemic stroke episodes with the same symptoms after the index stroke. Magnetic resonance angiographic examinations revealed serial changes in middle cerebral artery stenosis. After administration of an antiplatelet agent and hydroxyurea, he had no additional strokes.
Subject(s)
Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Brain Ischemia/etiology , Stroke/etiology , Thrombocythemia, Essential/complications , Thrombocythemia, Essential/drug therapy , Aged , Aphasia/etiology , Cerebral Angiography , Cilostazol , Diffusion Magnetic Resonance Imaging , Hemiplegia/etiology , Humans , Hydroxyurea/therapeutic use , Infarction, Middle Cerebral Artery/complications , International Normalized Ratio , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , Perceptual Disorders/etiology , Platelet Aggregation Inhibitors/therapeutic use , Tetrazoles/therapeutic use , Warfarin/adverse effects , Warfarin/therapeutic useABSTRACT
X-linked adrenoleukodystrophy is a severe and progressive neurodegenerative disease caused by the peroxisomal transporter ATP-binding cassette, subfamily D, member 1 gene mutations. The defect of this gene product results in accumulation of very-long-chain fatty acids in organs and serum, central demyelination, and peripheral axonopathy. Although there are different magnetic resonance (MR) findings which reflect various phenotypes in adrenoleukodystrophy, some cases present with specific symmetrical occipital white-matter lesions. We describe a patient with adult-onset X-linked adrenoleukodystrophy with topographic disorientation, whose brain MR images revealed T2-signal hyperintensity along the occipito-pontine tract and lateral lemnisci, but not in the cortico-spinal tract in the brainstem. The occipito-pontine tract and lateral lemnisci were clearly detected using diffusion-tensor fiber tracking, suggesting that the topographic disorientation of this patient might be related to the occipito-pontine tract. MR tractography can effectively identify the occipito-pontine tract and may help to localize the fibers associated with clinical symptoms.