A Stroke of Undetermined Source in Geriatrics

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.