Rasyid Al, Mesiano Taufik, Kurniawan Mohammad, Hidayat Rakhmad, Eddy Yunus Reyhan, Novianto Endi, Ocktafiani Ocktafiani, Wiyarta Elvan, Harris Salim
Department of Neurology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Central Jakarta, Indonesia.
Department of Radiology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Central Jakarta, Indonesia.
Case Rep Dermatol Med. 2023 Mar 8;2023:6580971. doi: 10.1155/2023/6580971. eCollection 2023.
Stroke is one of the top causes of death and disability in several nations. Patients with psoriasis are susceptible to multiple comorbidities, including stroke. In addition to acute ischemic stroke, psoriasis and chronic inflammation require comprehensive treatment. Here, we present a comprehensive management case of a patient with an acute ischemic stroke and psoriasis. . A 42-year-old man came to the emergency department complaining of sudden left-sided weakness that started two and a half hours before being admitted to the hospital. The patient was treated with cyclosporine from 2013 to 2019 for a history of psoriasis. The patient was then treated for secondary stroke prevention using aspirin, vitamin B6, vitamin B12, folic acid, simvastatin, cyclosporine, and topical treatment. After two days of treatment, the patient's condition improved clinically, and he was discharged without further neurological deficits. As a home medication, the patient's cyclosporine was switched to the initial dose of methotrexate (7.5 mg/week) and titrated weekly to a response dose of 10 mg in the 10 week. After three months of follow-up, the patient's condition remained stable, devoid of similar symptoms or sequelae.
Cyclosporine should only be used for a maximum of 1 year for stroke management with psoriasis and be substituted for other systemic agents such as methotrexate. In addition, anticoagulants, antihypertensive, antihyperlipidemic, vitamin B6, vitamin 12, and folic acid regimens are highly recommended for comprehensive therapy of cardiovascular comorbidities.
中风是多个国家死亡和残疾的主要原因之一。银屑病患者易患多种合并症，包括中风。除急性缺血性中风外，银屑病和慢性炎症需要综合治疗。在此，我们介绍一例急性缺血性中风合并银屑病患者的综合管理病例。一名42岁男性因突发左侧肢体无力于入院前两个半小时前来急诊科就诊。该患者自2013年至2019年因银屑病病史接受环孢素治疗。随后患者使用阿司匹林、维生素B6、维生素B12、叶酸、辛伐他汀、环孢素进行二级中风预防治疗，并接受局部治疗。经过两天治疗，患者临床症状改善，出院时无进一步神经功能缺损。作为家庭用药，患者的环孢素换为甲氨蝶呤初始剂量（7.5毫克/周），并在第10周每周滴定至反应剂量10毫克。经过三个月随访，患者病情保持稳定，无类似症状或后遗症。
环孢素用于银屑病合并中风的治疗最多只能使用1年，应换用其他全身用药如甲氨蝶呤。此外，强烈推荐使用抗凝剂、抗高血压药、抗高血脂药、维生素B6、维生素12和叶酸方案对心血管合并症进行综合治疗。
