Gaddameedi Sai Rakshith, Khan Mahrukh A, Arty Fnu, Bandari Vandana, Vangala Anoohya, Panchal Pratik, Shah Shazia M
Internal Medicine, Monmouth Medical Center, Long Branch, USA.
Internal Medicine, Rutgers Health/Monmouth Medical Center, Long Branch, USA.
Cureus. 2024 May 14;16(5):e60300. doi: 10.7759/cureus.60300. eCollection 2024 May.
Symptomatic cerebral infarcts with cryptogenic ischemic stroke pose diagnostic challenges due to unknown etiology. Notably, up to half of young individuals with cryptogenic stroke exhibit patent foramen ovale (PFO), while finasteride, which is used for male pattern baldness, elevates testosterone levels, potentially increasing the risk of thrombosis. Here, we present a case of thalamic infarction in a 21-year-old male devoid of cerebrovascular risk factors but with PFO and finasteride use. The patient presented with short-term memory issues, otherwise lacking medical history or substance use. Examination revealed neurological deficits, with imaging indicating a left thalamic infarct. Subsequent investigations identified PFO, prompting referral for closure, yielding symptomatic improvement. Furthermore, discontinuation of finasteride was advised due to its thrombotic association. Finasteride's inhibition of 5-alpha reductase 2 increases testosterone conversion to estrogen, potentially promoting thrombosis. Finasteride use can cause thrombotic events, emphasizing its risk. In conclusion, young embolic stroke patients warrant PFO evaluation alongside hypercoagulable workup, with closure benefiting those under the age of 55. Additionally, discontinuing finasteride may mitigate thrombosis risk.
病因不明的隐源性缺血性卒中所致的症状性脑梗死带来了诊断挑战。值得注意的是，高达一半的年轻隐源性卒中患者存在卵圆孔未闭（PFO），而用于治疗男性型脱发的非那雄胺会提高睾酮水平，可能增加血栓形成风险。在此，我们报告一例21岁男性丘脑梗死病例，该患者无脑血管危险因素，但存在PFO且使用非那雄胺。患者出现短期记忆问题，除此之外无病史或药物使用史。检查发现神经功能缺损，影像学检查显示左侧丘脑梗死。随后的检查发现了PFO，促使其转诊进行封堵，症状得到改善。此外，鉴于非那雄胺与血栓形成有关，建议停用。非那雄胺对5-α还原酶2的抑制作用会增加睾酮向雌激素的转化，可能促进血栓形成。使用非那雄胺会导致血栓形成事件，凸显了其风险。总之，年轻的栓塞性卒中患者在进行高凝检查的同时需要评估PFO，55岁以下患者进行封堵有益。此外，停用非那雄胺可能会降低血栓形成风险。
