Department of Neurosurgery, Nagoya University of Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan.
Department of Neurosurgery, Nagoya University of Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan.
J Stroke Cerebrovasc Dis. 2022 Jul;31(7):106526. doi: 10.1016/j.jstrokecerebrovasdis.2022.106526. Epub 2022 Apr 27.
Congenital afibrinogenemia is an autosomal recessive inherited disorder that can cause thrombotic as well as hemorrhagic events. We describe a case of repeated mild ischemic strokes due to a mural thrombus in the carotid artery and our medical treatment.
A 49-year-old woman with congenital afibrinogenemia developed two minor ischemic strokes in two months. Clinical images revealed scattered fresh infarcts in the right middle cerebral artery region and mild cervical carotid artery stenosis. The risk for surgical treatment was considered to be extraordinarily high. The patient was treated with 100 mg/day of aspirin and 3 g fibrinogen infusion every two weeks. After the one-year course of medication, the mural thrombus gradually decreased, and there were no bleeding or ischemic stroke events.
This case report highlights the successful treatment of an ischemic stroke in a patient with a congenital afibrinogenemia with an antiplatelet agent and fibrinogen replacement. There are no guidelines for managing ischemic stroke in patients with congenital afibrinogenemia, and further studies are needed.
先天性无纤维蛋白原血症是一种常染色体隐性遗传性疾病，可引起血栓形成和出血事件。我们描述了一例因颈动脉壁血栓形成导致的反复轻度缺血性中风病例，以及我们的治疗方法。
一名 49 岁女性患有先天性无纤维蛋白原血症，在两个月内发生了两次轻微的缺血性中风。临床图像显示右侧大脑中动脉区域有散在的新鲜梗死灶和轻度颈内颈动脉狭窄。手术治疗的风险被认为极高。患者每天接受 100mg 阿司匹林和每两周 3g 纤维蛋白原输注治疗。经过一年的药物治疗后，壁血栓逐渐减少，没有出血或缺血性中风事件发生。
本病例报告强调了使用抗血小板药物和纤维蛋白原替代物成功治疗先天性无纤维蛋白原血症患者的缺血性中风。目前尚无管理先天性无纤维蛋白原血症患者缺血性中风的指南，需要进一步研究。
