A Stroke of Undetermined Source in Geriatrics
Fiammetta Monacelli *
Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genova, 16132, Italy.
Federica Gandolfo
Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genova, 16132, Italy.
Patrizio Odetti
Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genova, 16132, Italy.
*Author to whom correspondence should be addressed.
Abstract
Presentation of the Case: Criptogenetic strokes represent a challenge, particularly in geriatrics as the patient’s clinical complexity, the polipharmacotherapy, the epigenetic modifications of a life course may complicate the case clinical presentation and the prognosis. We report the case of a young old woman admitted to hospital for an ischemic stroke recurrence associated to a leg deep venous thrombosis. The medical history was negative for traditional cardiovascular risk factors, excluding a mild carotid atherosclerotic plaque, for rheumatologic/autoimmune or oncological diseases. Haematological malignancies were also ruled out. The coagulative panel showed the prothrombin G202110A gene heterozygote mutation.
Discussion: The clinical case adds an interesting narrative frame to the issue of criptogenetic strokes in geriatrics; the mutation of the prothrombin G202110A gene might act synergistically to comorbidity disrupting the atherosclerotic plaque. Immunosenescence, clinical frailty, gender difference and the epigenetic modifications might contribute to stratify a higher pro thrombotic risk for this individual patient.
Conclusion: This case strengthens the need to tackle the elderly clinical complexity, through tailored approaches on the single patient.
Keywords: Criptogenetic strokes, elderly frailty cumulative index, prothrombin G202110A gene mutation.