Prevalence of Fabry disease in patients with cryptogenic stroke: a prospective study.
BACKGROUND
Strokes are an important cause of morbidity and mortality in young adults. However, in most cases the cause of the stroke remains unclear. Anderson-Fabry disease is an X-linked recessive lysosomal storage disease resulting from deficient alpha-galactosidase and causes an endothelial vasculopathy followed by cerebral ischaemia. To determine the importance of Fabry disease in young people with stroke, we measured the frequency of unrecognised Fabry disease in a cohort of acute stroke patients.


METHODS
Between February, 2001, and December, 2004, 721 German adults aged 18 to 55 years suffering from acute cryptogenic stroke were screened for Fabry disease. The plasma alpha-galactosidase activity in men was measured followed by sequencing of the entire alpha-GAL gene in those with low enzyme activity. By contrast, the entire alpha-GAL gene was genetically screened for mutations in women even if enzyme activity was normal.


RESULTS
21 of 432 (4.9%) male stroke patients and seven of 289 (2.4%) women had a biologically significant mutation within the alpha-GAL gene. The mean age at onset of symptomatic cerebrovascular disease was 38.4 years (SD 13.0) in the male stroke patients and 40.3 years (13.1) in the female group. The higher frequency of infarctions in the vertebrobasilar area correlated with more pronounced changes in the vertebrobasilar vessels like dolichoectatic pathology (42.9%vs 6.8%).


CONCLUSIONS
We have shown a high frequency of Fabry disease in a cohort of patients with cryptogenic stroke, which corresponds to about 1.2% in young stroke patients. Fabry disease must be considered in all cases of unexplained stroke in young patients, especially in those with the combination of infarction in the vertebrobasilar artery system and proteinuria.
Rolfs
Arndt
A
Department of Neurology, University of Rostock, Rostock, Germany. arndt.rolfs@med.uni-rostock.de
Böttcher
Tobias
T
Zschiesche
Marlies
M
Morris
Peter
P
Winchester
Bryan
B
Bauer
Peter
P
Walter
Uwe
U
Mix
Eilhard
E
Löhr
Mathias
M
Harzer
Klaus
K
Strauss
Ulf
U
Pahnke
Jens
J
Grossmann
Annette
A
Benecke
Reiner
R
D000328:Adult; D015331:Cohort Studies; D000795:Fabry Disease / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D020521:Stroke / Q000145:classification / Q000150:complications* / Q000503:physiopathology; D000519:alpha-Galactosidase / Q000235:genetics* / Q000378:metabolism
D000519:alpha-Galactosidase