Abstract
Disorders involving the vascular system of the brain are numerous and sundry. Atherosclerotic
thromboembolism of large vessels and lacunar infarctions of small vessel disease are
well known. Brain infarction due to cardioembolism is common as well, and even more
so when diligently sought. Rupture of intracranial blood vessels results in subarachnoid
and intraparenchymal hemorrhage. We present four cases of stroke of uncommon cause
and remind clinicians to be open minded to the many possible causes of stroke, in
particular because early recognition and treatment is often critical. Case 1 discusses
a patient with inflammatory cerebral amyloid angiopathy. The presentation, ability
to recur, and current treatment considerations are reviewed. Case 2 discusses microangiopathic
thrombotic angiopathy. Diagnosis and treatment are considered. An association with
interferon therapy and the evolving terminology of this and related conditions are
discussed. Case 3 discusses intracranial hemorrhage secondary to acute promyelocytic
leukemia. Patients with acute leukemias require aggressive management of their coagulopathy,
thrombocytopenia, and the disease itself. Finally, Case 4 discusses ischemic stroke
due to a paradoxical embolism in the setting of a patent foramen ovale (PFO). Both
medical and surgical management of a PFO for stroke prevention are considered.
Keywords
cerebral amyloid angiopathy - microhemorrhage - thrombotic microangiopathy - interferon
therapy - acute promyelocytic leukemia - patent foramen ovale
