title: [Nephrotic syndrome might be an inhibitor of the endovascular recanalization in a patient with acute ischemic stroke].
abstract: A 65-year-old man with left hemiparesis was referred to our hospital by ambulance. Diffusion-weighted magnetic resonance imaging (DWI-MRI) showed a slight hyperintensity area in the right basal ganglion and deep white matter, and brain magnetic resonance angiography (MRA) revealed right middle cerebral artery (MCA) occlusion in the M1 proximal segment. Receiving intravenous rt-PA therapy, the patient showed no neurological improvement. Therefore emergency neuroendovascular revasculization was decided. After the first evacuation of the clot, the occlusion site was partly recanalyzed. However it was re-occluded after a few minutes. Then, mechanical disruption using balloon catheters were added for the occlusion site allowing it to be recanalyzed. After the acute ischemic stroke therapy, the patient was diagnosed as nephrotic syndrome, because his blood chemistry test indicated hypoproteinemia and urine examination showed proteinuria. Renal biopsy confirmed nephrotic syndrome due to AL amyloidosis. Nephrotic syndrome causes hypercoagulability and increases platelet aggregation. Thus we speculated that nephrotic syndrome inhibited the early recanalization in this patient.
authors: Department of Neurology, Graduate School of Medical Sciences, Kumamoto University.
authors: Toshihito
authors: T
authors: Nakanishi
authors: Masaki
authors: M
authors: Watanabe
authors: Makoto
authors: M
authors: Nakajima
authors: Nao
authors: N
authors: Nojiri
authors: Akira
authors: A
authors: Oda
authors: Yukio
authors: Y
authors: Ando
mesh_terms: D000368:Aged; D000686:Amyloidosis / Q000150:complications*; D002548:Cerebral Revascularization / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000209:etiology* / Q000628:therapy; D008297:Male; D009404:Nephrotic Syndrome / Q000209:etiology*; D019635:Neurosurgical Procedures / Q000379:methods*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012008:Recurrence; D020521:Stroke / Q000150:complications / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator