This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wityk, R. J. Articles by Oppenheimer, S. Search for Related Content PubMed PubMed Citation Articles by Wityk, R. J. Articles by Oppenheimer, S. Related Collections Embolic stroke Intracerebral Hemorrhage Stroke in Children and the Young Transient Ischemic Attacks

(Stroke. 2002;33:680.)
© 2002 American Heart Association, Inc.

Original Contributions

Neurovascular Complications of Marfan Syndrome

A Retrospective, Hospital-Based Study

Robert J. Wityk, MD; Carla Zanferrari, MD Stephen Oppenheimer, MD, PhD

From the Department of Neurology (R.J.W., S.O.), Johns Hopkins Hospital, Baltimore, Md; Instituto Di Neurologica (C.Z.), Università Degli Studi Di Parma, Parma, Italy; and Neuroscience Division (S.O.), PharmaNet, Inc, Princeton, NJ.

Correspondence to Robert J. Wityk, MD, Meyer 5-181, 600 North Wolfe St, Baltimore, MD 21287. E-mail rwityk{at}jhmi.edu

Background and Purpose— Small case series have associated Marfan syndrome with cerebral and spinal ischemia or hemorrhage. However, there has been no investigation of the frequency and etiology of neurovascular disorders in a large series of Marfan patients.

Methods— We conducted a retrospective, hospital-based study of all Marfan syndrome patients seen in an 8-year period. Records were reviewed in detail, and clinical characteristics of those with and without a neurovascular diagnosis compared.

Results— Of 513 patients, 18 (3.5%) had a neurovascular diagnosis, as follows: transient ischemic attack (11), cerebral infarction (2), spinal cord infarction (2), subdural hematoma (2), and spinal subarachnoid hemorrhage (1). A cardioembolic source was identified in 12 of 13 patients with cerebral ischemia, as follows: prosthetic heart valves (9), mitral valve prolapse (2), and atrial fibrillation (1). Chronic anticoagulant therapy was a likely cause in 2 of 3 patients with hemorrhagic events. Compared with other Marfan syndrome patients, those with neurovascular events were older (39.6 versus 31.7 years, P=0.04) and more likely to be in atrial fibrillation (22.2% versus 3.2%, P=<0.01), to have prosthetic heart valves (61.1% versus 7.7%, P=0.001), and to be taking anticoagulant therapy (72.2% versus 16.1%, P<0.001). Aortic disease, a putative factor in the etiology of neurovascular complications, was present in equal measure in Marfan patients with and without neurovascular complications (78% versus 65%, P=NS).

Conclusions— Neurovascular complications of Marfan syndrome are rare during 8 years of follow-up, and generally are ischemic in nature. A high-risk cardiac source was identified in the majority. A significant association with vascular dissection was not established.

Key Words: cerebral ischemia, transient • Marfan syndrome • stroke

This article has been cited by other articles:

				S. Debette and H. S. Markus The Genetics of Cervical Artery Dissection: A Systematic Review Stroke, June 1, 2009; 40(6): e459 - e466. [Abstract] [Full Text] [PDF]

				J. Francis, S. Raghunathan, and P. Khanna The role of genetics in stroke Postgrad. Med. J., September 1, 2007; 83(983): 590 - 595. [Abstract] [Full Text] [PDF]