症例は60歳女性．約10年前に心筋梗塞を発症し，経皮的冠動脈形成術がなされた．約3年前に穿通枝領域の脳梗塞を発症して他院で加療を受け，抗血小板薬が導入された．当時の頭部MRI/MR angiography（MRA）では陳旧性の穿通枝梗塞巣が散見され，頭頚部主幹動脈に狭窄や閉塞は認めなかった．今回，穿通枝梗塞を再発して当科へ入院となり，繰り返す虚血性血管イベントに対して原因精査を行い，弾性線維性仮性黄色腫（pseudoxanthoma elasticum: PXE）の確定診断に至った．本疾患は常染色体劣性遺伝の形式をとり，若年性心血管イベントや網膜下出血・消化管出血の要因となり得る．根本的治療はいまだなく，高血圧や脂質異常などの危険因子の管理が一般的となっている．非高齢者の再発性穿通枝梗塞患者においては，本症を鑑別に挙げることが併発症の管理の面からも重要になると考えられる．

BACKGROUND Patients who have suffered from cerebral ischemia have a high risk of recurrent vascular events. Predictive models based on classical risk factors typically have limited prognostic value. Given that cerebral ischemia has a heritable component, genetic information might improve performance of these risk models. Our aim was to develop and compare two models: one containing traditional ...

Adherence to antihypertensive agents after ischemic stroke and risk of cardiovascular outcomes The authors examined 14,227 patients with ischemic stroke who were treated with antihypertensive (AH) agents. Each case was matched to 15 controls. Adherence to AH agents was associated with adherence to other secondary preventive therapies and a risk reduction for nonfatal vascular events after an is...

Stroke prevention in patients with atrial fibrillation (AF) using anticoagulants involves weighing the benefits of reduced ischemic stroke1,2 against elevated risks serious bleeding events.3 Warfarin and direct oral (DOACs) are available for this indication.