Date of Presentation
5-2-2024 12:00 AM
College
Rowan-Virtua School of Osteopathic Medicine
Poster Abstract
Introduction
Systemic sclerosis is an autoimmune disorder characterized by microvascular damage and multiorgan fibrosis. These patients have a higher risk of cerebrovascular events, but it is difficult to develop strategies for prevention due to limited understanding of underlying pathophysiology.
Case Presentation
A 76-year-old female with a history of systemic sclerosis presented to the emergency department with acute onset slurred speech, facial droop, and left arm pain with a National Institutes of Health (NIH) Stroke Scale of 1. She was outside the thrombolytic window. Other history includes hypertension and hyperlipidemia; both were well controlled. MRI confirmed right frontal lobe ischemic stroke with additional ischemic foci in the temporal and parietal lobe. CTA neck and echocardiogram were negative for emboli source, and LDL was within normal limits. She was started on dual antiplatelet therapy (DAPT). The patient’s condition improved and by day 2 the only residual symptom was facial droop. She was discharged on DAPT with plans to transition to Plavix monotherapy after 90 days.
Discussion
This case illustrates the risk of CVA in a patient with systemic sclerosis. The patient’s other major risks for CVA include hypertension and hyperlipidemia, both of which were well controlled. For this reason, along with negative imaging, we suspect systemic sclerosis is the most probable cause of CVA. Long-term aspirin therapy is the consensus for prevention, however there are no clear cut guidelines. Due to aspirin failure, she will be transitioned to Plavix following completion of DAPT.
Conclusion
Further research into pathophysiology and prevention of stroke in this population is needed.
Keywords
systemic sclerosis, Cerebrovascular Accident, scleroderma, CVA, Stroke, Aspirin
Disciplines
Diagnosis | Internal Medicine | Medicine and Health Sciences | Nervous System Diseases | Pathological Conditions, Signs and Symptoms | Quality Improvement | Rheumatology | Skin and Connective Tissue Diseases | Therapeutics
Document Type
Poster
DOI
10.31986/issn.2689-0690_rdw.stratford_research_day.174_2024
Included in
Diagnosis Commons, Internal Medicine Commons, Nervous System Diseases Commons, Pathological Conditions, Signs and Symptoms Commons, Quality Improvement Commons, Rheumatology Commons, Skin and Connective Tissue Diseases Commons, Therapeutics Commons
CVA in Patient with Systemic Sclerosis on Aspirin Therapy: A Case Report
Introduction
Systemic sclerosis is an autoimmune disorder characterized by microvascular damage and multiorgan fibrosis. These patients have a higher risk of cerebrovascular events, but it is difficult to develop strategies for prevention due to limited understanding of underlying pathophysiology.
Case Presentation
A 76-year-old female with a history of systemic sclerosis presented to the emergency department with acute onset slurred speech, facial droop, and left arm pain with a National Institutes of Health (NIH) Stroke Scale of 1. She was outside the thrombolytic window. Other history includes hypertension and hyperlipidemia; both were well controlled. MRI confirmed right frontal lobe ischemic stroke with additional ischemic foci in the temporal and parietal lobe. CTA neck and echocardiogram were negative for emboli source, and LDL was within normal limits. She was started on dual antiplatelet therapy (DAPT). The patient’s condition improved and by day 2 the only residual symptom was facial droop. She was discharged on DAPT with plans to transition to Plavix monotherapy after 90 days.
Discussion
This case illustrates the risk of CVA in a patient with systemic sclerosis. The patient’s other major risks for CVA include hypertension and hyperlipidemia, both of which were well controlled. For this reason, along with negative imaging, we suspect systemic sclerosis is the most probable cause of CVA. Long-term aspirin therapy is the consensus for prevention, however there are no clear cut guidelines. Due to aspirin failure, she will be transitioned to Plavix following completion of DAPT.
Conclusion
Further research into pathophysiology and prevention of stroke in this population is needed.