Fabry disease is a multisystem lysosomal storage disorder with serious effects including cardiomyopathy and renal failure. Although neurological involvement at presentation is unusual, it is increasingly recognised that Fabry disease may present with ischaemic strokes and may be responsible for up to 5% of cryptogenic strokes in young men.1 Early recognition is vital to permit early therapeutic intervention and family screening, and could prevent clinical progression and recurrent stroke. We report a patient who presented with recurrent brainstem ischaemic strokes due to Fabry disease, with no evidence of systemic manifestations at presentation. Fabry disease should be considered in cases of cryptogenic stroke (especially young men with vertebrobasilar territory symptoms) even without multisystem involvement.

Case report

In January 2007, a 24-year-old man was admitted with sudden rotatory vertigo and nausea. He reported three previous similar episodes. In 2004, he had diplopia for 5 days; later that year, he experienced transient vertigo and gait ataxia. The third episode occurred in February 2005, when he suffered the abrupt onset of unsteadiness, nausea, slurred speech and right-sided weakness. An MRI scan of the brain at this time showed a lesion of high signal on T2-weighted images in the left pons; MR angiography, carotid duplex scan and transoesophageal echocardiogram (TOE) were normal. Demyelination was considered, but when a cerebrospinal fluid (CSF) examination failed to show oligoclonal bands, a diagnosis of probable cryptogenic stroke was made. …