ADVANCED NEUROVASCULAR STENOSIS AS A PRESENTING FEATURE IN NIDDM

M.E. Yeolekar, N.D. Karnik, A.A. Manerkar,Lokmanya Tilak Municipal Medical College & General Hospital.

Vascular disease in Type 2 diabetic patients may pre-date the diagnosis of hyperglycaemia.  Increased thickness of intimal and medial layers of carotid arteries is reported  in patients with impaired glucose tolerance.

Presented here is a 40 year old left handed bus conductor, non smoker who developed sudden inability to communicate.  There were no prior h/o fits, paresis, unconsciousness, head injury, hypertension or diabetes.   On examination pulse 86/min regular, right carotid pulse was weak without a bruit; BP was 112/80 mm Hg.  He had global aphasia.  Cranial nerves and motor system were normal.  Other systems revealed no abnormality.  Investigations : Hb 14.9gm%, PCV 48%, Cholesterol 180mg%, Triglycerides 53mg%.  Fasting blood glucose 444mg%, post lunch 352mg%.  Carotid Doppler revealed fibrofatty hypoechoic plaque within the tip of right common carotid artery extending into origin of right internal carotid artery causing 71% area reduction.  Diffuse intimal thickening within left distal common carotid artery was also noted.  Anticardiolipin and antiphosphlipid antibodies were negative.  CT Scan revealed hypodensities in right anterolateral temporal lobe,  and parts of right frontal and parietal lobes.

This case highlights the presentation of cerebrovascular disease with carotid atherosclerosis in a young male preceeding clinical diabetes.  Possible causes are postulated.  Higher index of suspicion and early detection of diabetics appear to be crucial.