J Korean Neurol Assoc.  2019 Nov;37(4):361-367. 10.17340/jkna.2019.4.4.

Characteristics of Acute Cerebral Infarction in Patients with Familial Hypercholesterolemia

• Kim J
• Park SH
• Kim JM
• Lee SH
• Park KY

• KMID: 2464139
• DOI: http://doi.org/10.17340/jkna.2019.4.4

Abstract

BACKGROUND
The patients with familial hypercholesterolemia (FH) suffer from early onset atherosclerotic vascular disease due to high level of cholesterol and subsequent vascular inflammation, especially in the form of coronary artery disease. We investigated the clinical characteristics of FH associated cerebral infarction and its possible mechanism.
METHODS
Between January 2014 and May 2017, acute cerebral infarction patients who admitted to Chung-Ang University Hospital were reviewed from stroke registry and the diagnosis of FH was made based on the Dutch Lipid Clinic Network Diagnostic Criteria for FH. We reviewed their initial laboratory and brain imaging information, prescribed medication and followed lipid profile after discharge. Stroke mechanism was determined based on Trial of ORG 10172 in Acute Stroke Treatment classification.
RESULTS
Among 1,401 acute cerebral infarction or transient ischemic attack patients, one probable and three possible FH stroke patients were detected. All the patients denied of previous coronary artery disease history and initial lipid panel revealed high levels of total cholesterol (378±75 mg/dL) and low-density lipoprotein-cholesterol (238±56 mg/dL). Stroke mechanisms were heterogeneous, including one atherosclerotic, two vertebral artery dissection cases and one coagulation disorder. All the patients were combined with noticeable degree of intracranial atherosclerosis and were maintained with statin treatment.
CONCLUSIONS
This study illustrates diverse stroke mechanism among stroke patients with FH. Further research is required to disclose exact incidence of FH among stroke population and effective treatment strategy.

Keyword

Familial hypercholesterolemia; Stroke; Atherosclerosis

MeSH Terms

Atherosclerosis
Cerebral Infarction*
Cholesterol
Classification
Coronary Artery Disease
Diagnosis
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Hyperlipoproteinemia Type II*
Incidence
Inflammation
Intracranial Arteriosclerosis
Ischemic Attack, Transient
Neuroimaging
Stroke
Vascular Diseases
Vertebral Artery Dissection
Cholesterol