Mizutani Keisuke, Sakurai Keita, Mizuta Ikuko, Mizuno Toshiki, Yuasa Hiroyuki
Department of Neurology, Tosei General Hospital, Seto, Aichi, Japan.
Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan.
J Stroke Cerebrovasc Dis. 2020 May;29(5):104701. doi: 10.1016/j.jstrokecerebrovasdis.2020.104701. Epub 2020 Feb 24.
Patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) can develop multiple border-zone infarcts due to hypotension, hypovolemia, or surgery. We report the case of a 41-year-old woman with CADASIL who developed multiple border-zone infarcts due to influenza A virus infection. The patient had no apparent history or episode of stroke or altered consciousness following the onset of respiratory symptoms, which were due to the influenza A infection. Diffusion-weighted magnetic resonance images of the brain showed multiple acute-phase infarcts in border-zone areas of both cerebral hemispheres and the corpus callosum; fluid-attenuated inversion-recovery magnetic resonance images showed increased signal in the subcortical areas of both temporal poles. Gene analysis identified a heterozygous mutation c.160C>T in exon 2 of the NOTCH3 gene (p.Arg54Cys). A diagnosis of CADASIL was established. Our case demonstrates that infectious conditions such as influenza A can trigger multiple border-zone infarctions in patients with CADASIL.
患有伴有皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病（CADASIL）的患者，可能会因低血压、血容量不足或手术而发生多处边缘带梗死。我们报告一例41岁患有CADASIL的女性患者，其因甲型流感病毒感染而发生多处边缘带梗死。该患者在出现因甲型流感感染引起的呼吸道症状后，没有明显的卒中病史或发作，也没有意识改变。脑部弥散加权磁共振成像显示双侧大脑半球和胼胝体边缘带区域有多处急性期梗死；液体衰减反转恢复磁共振成像显示双侧颞极皮质下区域信号增强。基因分析确定NOTCH3基因外显子2存在杂合突变c.160C>T（p.Arg54Cys）。确诊为CADASIL。我们的病例表明，甲型流感等感染性疾病可引发CADASIL患者发生多处边缘带梗死。
