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JAMA Neurology Clinical Challenge
May 2018

Recurrent Ischemic and Hemorrhagic Strokes in a Young Adult

Author Affiliations
  • 1Department of Neurology, Massachusetts General Hospital, Boston
  • 2Department of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil
JAMA Neurol. 2018;75(5):628-629. doi:10.1001/jamaneurol.2018.0403

An Indian man in his early 40s was admitted for evaluation of recurrent ischemic and hemorrhagic strokes. His medical history included hypertension and gout. He first presented 7 years ago with dizziness, dysarthria, and left hemiparesis. Brain magnetic resonance imaging (MRI) showed an acute right corona radiata infarct and 2 right perisylvian ring-enhancing and nodular granulomatous lesions (Figure 1A). Results of head and neck MR angiography were normal. Two weeks after admission he developed fever and asthenia. Brain MRI showed a new right perisylvian lesion with meningeal enhancement. Follow-up MRI after 8 months showed a new right parietal nodular lesion and a right parietal hemorrhage.

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