Abstract Details

Title Acute Ischemic Stroke In a Patient with Neonatal Marfan’s Syndrome

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P8 - Poster Session 8 (8:00 AM-9:00 AM)

Poster/Presentation
Number 14-013

Objective N/A

Background

Neonatal Marfan Syndrome is more rare with a more severe course and poorer prognosis than classical Marfan Syndrome. Infants are born with clinical features including arachnodactyly, elbow and knee joint contracture, camptodactyly, ectopia lentis among others, and the diagnosis is further supported by a positive fibrillin-1 gene mutation. Neurological complications include acute ischemic stroke. We present a unique case of acute ischemic stroke in a patient with Neonatal Marfan Syndrome, treated with mechanical thrombectomy.

Design/Methods N/A

Results A 6-year-old boy with history of neonatal Marfan Syndrome, mitral regurgitation with valve repair and aortic root repair, presented to the ED after a fall and progressive lethargy at home. The patient was admitted for syncope work up with cardiac work up revealing globally decreased cardiac function and multiple intracardiac thrombi. He was admitted to the PICU for cardiogenic shock and started on a heparin drip. The patient developed a right MCA syndrome, leading to diagnosis of R MCA M1 branch occlusion that was swiftly treated with a mechanical thrombectomy. MRI brain revealed bilateral MCA infarcts and numerous chronic microhemorrhages, which were deemed to be sequelae of Marfan’s syndrome. He was extubated, started on heparin drip, and cardiac care was continued. Genetics team arranged for follow-up appointment.

Conclusions This case demonstrates the use of mechanical thrombectomy as a successful treatment option for ischemic stroke in a patient with Neonatal Marfan Syndrome. Despite the complex nature of the case, including the risks of undergoing anesthesia in a patient with multiple cardiac comorbidities and chronic cortical and subcortical microhemorrhages, the patient was able to undergo a successful mechanical thrombectomy to improve long-term neurological outcomes. This case highlights that mechanical thrombectomy can potentially be a viable option to treat similar patients who present with neurological complications such as cardioembolic stroke from cardiac comorbidities associated with Marfan Syndrome.

Authors/Disclosures
Gautham V. Upadrasta, MD PRESENTER	Dr. Upadrasta has nothing to disclose.
Michelle Ganat, MD (Montefiore Medical Center)	Dr. Ganat has nothing to disclose.
Kush Sharma, MBBS	Dr. Sharma has nothing to disclose.
Oleg Otlivanchik, MD (Montefiore Medical Center)	Dr. Otlivanchik has nothing to disclose.

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