Neurology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the course for this article:
 Volume 69, Number 11, September 11, 2007
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Zubkov, A. Y.
Right arrow Articles by Wijdicks, E. F.M.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Zubkov, A. Y.
Right arrow Articles by Wijdicks, E. F.M.
Related Collections
Right arrow Other cerebrovascular disease/ Stroke
Right arrow Hematologic
Right arrow All Cerebrovascular disease/Stroke
NEUROLOGY 2007;69:1136-1141
© 2007 American Academy of Neurology

Primary systemic amyloidosis with ischemic stroke as a presenting complication

Alexander Y. Zubkov, MD, PhD, Alejandro A. Rabinstein, MD, Angela Dispenzieri, MD and Eelco F.M. Wijdicks, MD

From the Mayo Clinic, Department of Neurology (A.Y.Z., A.A.R., E.F.M.W.) and Division of Hematology (A.D.), Rochester, MN.

Address correspondence and reprint requests to Dr. Eelco Wijdicks, Mayo Clinic, Division of Critical Care Neurology, Department of Neurology, 200 First Street SW, Rochester, MN 55901 wijde{at}mayo.edu

Background: Amyloidosis is an uncommon disorder that ultimately leads to fatal multiorgan failure. Ischemic strokes have been sporadically described but are not well characterized. The purpose of this study was to review the pathophysiologic relationship between primary systemic amyloidosis and ischemic stroke, and to determine how often stroke is the first defining manifestation.

Methods: Retrospective study of 49 patients with confirmed primary amyloidosis and ischemic stroke. All included patients had biopsy proven amyloidosis.

Results: Forty patients were included in the study. Ischemic strokes occurred in 13 patients (32.5%) as the initial presentation of amyloidosis. Patients with initial stroke presentation had the worst outcome, with average survival of 6.9 months after established diagnosis with amyloidosis; strokes developed 9.6 months before diagnosis with primary amyloidosis. Thirty-seven percent experienced recurrent ischemic stroke. The majority (70%) of patients had cardioembolic infarctions.

Conclusions: Ischemic stroke is an underappreciated complication of primary amyloidosis. In the absence of obvious clinical and cardiogenic manifestations, primary amyloidosis should be considered when echocardiography demonstrates thickening of the valves, restrictive pattern, and increased echogenicity. Ischemic strokes as an initial presentation of primary amyloidosis carries a worse prognosis.

Abbreviations: AA = secondary amyloidosis; AF = familial amyloidosis; AL = immunoglobulin light-chain amyloidosis; CHF = congestive heart failure; GI = gastrointestinal; LV = left ventricular; NS = not significant; PE = pericardial effusion; TOAST = Trial of Org 10172 in Acute Stroke Treatment; VS = ventricular septum.

Disclosure: The authors report no conflicts of interest.

Received November 13, 2006. Accepted in final form April 11, 2007.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2007 by AAN Enterprises, Inc.