title: Recurrent small-artery disease in hyperhomocysteinemia: widowers' stroke syndrome?
abstract: Hyperhomocysteinemia is thought to cause ischemic strokes. We report two middle-aged widowers with frequent recurrences of small-artery strokes, two capsular infarcts and a thalamic hemorrhage in one patient, and two thalamic and pontine infarcts in the other. Blood tests following the final stroke showed hyperhomocysteinemia and methylenetetrahydrofolate reductase C677T gene mutation, with low concentration of vitamin B6. Multivitamin supplementation normalized plasma homocysteine levels in both patients. Hyperhomocysteinemia is treatable; therefore, serum homocysteine should be measured as a potential risk factor for stroke recurrence in relatively young patients with recurrent small-artery infarctions or hemorrhage, especially those with insufficient lifestyle factors.
authors.affiliation: Department of Cerebrovascular Disease and Clinical Research Institute, National Kyushu Medical Center, Fukuoka.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Uwatoko
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Shimada
authors.forename: Noriko
authors.initials: N
authors.lastname: Hagiwara
authors.forename: Shigeru
authors.initials: S
authors.lastname: Fujimoto
authors.forename: Setsuro
authors.initials: S
authors.lastname: Ibayashi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okada
mesh_terms: D002543:Cerebral Hemorrhage / Q000209:etiology; D002544:Cerebral Infarction / Q000209:etiology; D004032:Diet / Q000009:adverse effects; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications* / Q000188:drug therapy; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D008875:Middle Aged; D009154:Mutation; D012008:Recurrence; D020521:Stroke / Q000209:etiology*; D017805:Widowhood
chemical_list: D042965:Methylenetetrahydrofolate Reductase (NADPH2)