Atypical presentation of stroke in a person with autoimmune polyendocrine syndrome

Abstract

A 62-year-old man with type 1 diabetes mellitus presented to hospital with new onset anterograde amnesia in the absence of any other focal neurology or visual deficit. Computed tomography of his head revealed an established fronto-parietal infarct – however, it failed to detect the culprit acute infarct in the left temporal and occipital lobe, which was subsequently revealed by diffusion-weighted magnetic resonance imaging. This posterior cerebral artery stroke is thought to have been caused by thrombotic emboli.

This case highlights an atypical stroke presentation in the context of multiple endocrine comorbidities, including type 1 diabetes mellitus, coeliac disease and previously treated hyperthyroidism. This raises the possibility of an autoimmune polyendocrine syndrome. The patient was managed by the stroke and diabetes teams and is currently receiving cognitive rehabilitation in the community.

Learning points from this case hinge around recognition of atypical stroke presentations, the limitations of computed tomography in patients with stroke and the contributions that endocrine comorbidities may add to the risk of stroke.