Case

In March 1990, a 42-year-old man known to be an episodic heavy drinker and regular smoker suddenly developed a right visual field defect caused by a left occipital brain infarct. A few weeks prior to the index stroke he had an anteroseptal and inferior myocardial infarct, and after discharge from hospital, he had started to drink large amounts of alcohol daily. In April 1995, he developed a right occipital brain infarct. This 'accident' was again preceded by a drinking bout of about two weeks (900 g ethanol per week). On admission, clinical examination showed tubular vision. A computed tomography head scan revealed two separate infarcts located on the left and right occipital lobes. Duplex imaging of the carotid and vertebral arteries showed neither occlusions nor significant stenoses, but transthoracic echocardiography (TTE) showed left ventricular inferior and anteroapical hypokinetic segments without any thrombi. Three days after the onset of the latter stroke, the patient's platelet count amounted to 604, suggesting rebound thrombocytosis due to the recent cessation of prolonged heavy alcohol drinking. This patient was later diagnosed for a clinically definite mitochondrial disorder, but the presumed etiology ofhis strokes was probable cardiogenic embolism [21 ].

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