Is Ankylosing Spondylitis a Risk Factor of Recurrent Cerebrovascular Disease?

Special Article – Neurological Rehabilitation

Phys Med Rehabil Int. 2017; 4(2): 1115.

Is Ankylosing Spondylitis a Risk Factor of Recurrent Cerebrovascular Disease?

Zeynep Özözen Ayas*

Sakarya University Training and Research Hospital, Department of Neurology, Sakarya, Turkey

*Corresponding author: Zeynep Özözen Ayas, Sakarya University Training and Research Hospital, Department of Neurology, Adnan Menderes Road, Saglik St. No: 195, 54100, Adapazari, Sakarya, Turkey

Received: April 29, 2017; Accepted: May 25, 2017; Published: June 01, 2017

Abstract

Rheumatological diseases causing systemic vasculitis are one the causes of stroke in young patients.AS is a systemic inflammatory rheumatological disorder that primarily involves axial skeleton. AS may cause premature atherosclerosis. In addition, small vessel inflammation may play a role in the pathogenesis of vascular disease in patients with AS. Association of AS and cerebrovascular disease is rare. Herein, we discussed the role of AS as an etiological factor for recurrent stroke in young patient.

Keywords: Rheumatological diseases; Atherosclerosis; Cerebrovascular disease; Ankylosing spondylitis

Introduction

The etiology of ischemic stroke varies in the young. Rarely, some rheumatological diseases associated with some cerebrovascular events are implicated in the etiology. It is possible to reduce the risk of recurrent stroke episodes by performing a systematic evaluation and selecting appropriate treatments tailored to risk factors and stroke etiology in young patients. Concurrence of ankylosing spondylitis (AS) and stroke is rare. Herein, we discussed the role of AS as an etiological factor for recurrent stroke in young patient.

Case Presentation

A 36-year-old woman presented to hospital with numbness in her right arm and leg. Her medical history was remarkable for ankylosing spondylitis for 8 years, for which she was taking etanercept. She also had had ischemic stroke (right-sided pontine infarction) 1 year ago and was using acetyl salicylic acid 100mg since then. Her neurological examination was notable for left hemi hypoesthesia, left hemiparesis (5-/5, sequela), and left flexor plantar response. Her vital signs were stable and her routine hemogram and biochemical tests were within normal limits. Her electrocardiogram showed normal sinus rhythm. A cranial computerized tomography (CT) did not show any acute pathology. A brain diffusion and apparent diffusion co-efficient magnetic resonance imaging (MRI) examination revealed an area of acute infarction in left corona radiata (Figure 1). Additionally, there were ischemic gliotic changes consistent with small vessel disease in subcortical white matter on both sides on T2 and FLAIR sequences of brain MRI (Figure 2). The patient was admitted to our department. An electrocardiography and a carotid vertebral Doppler angiography taken for stroke etiology were both normal. Detailed vasculitis and genetic workup were done, and the ANA titer was found 1/1000 positive in a granular cytoplasmic pattern. A carotid MR angiogram, holter, and transthoracic echocardiogram taken to identify the etiology of recurrent stroke episodes at young age were all normal. The acetyl salicylic acid dose was increased to 300mg and the patient was discharged to return for follow-up visits.

Citation: Ayas ZÖ. Is Ankylosing Spondylitis a Risk Factor of Recurrent Cerebrovascular Disease?. Phys Med Rehabil Int. 2017; 4(2): 1115. ISSN : 2471-0377