An unusual cause of acute ischemic stroke: Adult Onset Still’s Disease


Adult Onset Still's Disease (AOSD) is a systemic inflammatory disease of unknown aetiology. The usual manifestations of AOSD are spiking fevers, arthritis, and an evanescent salmon-pink rash, with neurological manifestations occasionally described. Stroke is a rare manifestation of AOSD and the exact mechanism for stroke in AOSD remains unknown, although it has been hypothesized to be secondary to thrombocytosis or vasculitis. We present a case where acute ischemic stroke secondary to a floating internal carotid artery thrombus was an early manifestation of AOSD. The patient also had prolonged high spiking fevers, significant leucocytosis, arthralgias and transaminitis. He responded well to a high dose of oral corticosteroids and was eventually started on anticoagulation for secondary stroke prevention. To our knowledge, this is the first described case of arterial thrombosis associated with AOSD. We postulate that thrombocytosis, vasculitis and hypercoagulability from the underlying inflammatory state may have contributed to the ischemic stroke.

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Correspondence to Yihui Goh.

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Extracranial doppler findings showing mobile right internal carotid artery thrombus

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Goh, Y., Wong, V.Y., Tan, W.L. et al. An unusual cause of acute ischemic stroke: Adult Onset Still’s Disease. J Thromb Thrombolysis 49, 141–144 (2020).

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  • Adult Onset Still's Disease
  • Stroke
  • Arterial thrombosis
  • Hypercoagulability