ESOC 2019: Session Report: Rare Causes of Ischaemic Stroke

By: Derya ULUDUZ, Prof. M.D., Istanbul University, Cerrahpasa School of Medicine, Neurology Department. Istanbul, Turkey

The Rare Causes of Ischemic Stroke session took place on 23 May at 16.30 chaired by Dr Derya Uludüz and Dr Zdravka Poljakovic. Prof Uluduz pointed that rare causes require awareness and additional diagnostic techniques to prevent recurrences, provide future risk assessment and family counselling. To be familiar with those rare causes is important.

The first speaker was Prof Alexander Persu with his topic fibromuscular dysplasia (FMD). He mentioned that even FMD is a systemic disease, we should consider FMD in patients with severe chronic migraine headache, pulsatile tinnitus, stroke or carotid-vertebral dissections. And patients with FMD should undergo at least once in a lifetime full body CTA/MRA. He also suggested that young women with migraine and resistant hypertension should not only be evaluated for renal arteries but also cerebral arteries.

The very interesting topic cannabis and stroke was covered by Prof Michael Hill. He told us that cannabis use is a consequence rather than cause of bad behaviour in teens. Epidemiological evidence is modest for association between cannabis use and stroke and confounded by smoking, alcohol and other drug exposures. And there is a temporal association between cannabis and stroke where no other etiology is found. Cannabis use generally result with multiple intracranial stenosis causing stroke.

Prof Emmanuel Touze was the next speaker with title connective tissue disorders and stroke. He explained that connective tissue disorders are a group of diseases that affect connective tissue and usually chronic diseases. He explained clinical symptoms of different connective tissue disorders. Ehler Danlos disease can cause aneurysms, dissection, carotid cavernous fistula and rupture of large and medium sized arteries and cerebrovasculary manifestations occur in about 10% of patients. Osteogenesis imperfecta has the vasculary involvement due to atrial fibrillation, heart failure and aortic dissection. Cerebravascular manifestations are fairly rare and most commonly observed as cerebral artery dissections. Also he mentioned about Marfan Syndrome that has cerebravascular synptoms less that 5%. Marfan syndrome is mainly present with cardioembolic stroke and extension of aortic dissection.

Prof Armin Grau talked about the role of infections in stroke and Dr Jana Becker talked about vasculitis and stroke. She explained that primary central nervous system vasculitis has a wide range of clinical symptoms and it is often difficult to diagnose. Symptoms may sometimes overlap with reversible cerebral vasocontruction syndrome.