Hyperhomocysteinemia as a cause of premature stroke in a young patient

A case is presented of a woman who had an occlusive stroke at age 29. She was seen in a rehabilitation medicine clinic for central nervous system-mediated pain that had developed soon after a cerebrovascular event. After an extensive workup to find the cause of her cerebrovascular occlusion, it was discovered that she had a markedly elevated fasting plasma homocysteine level of 59 micromol/L. A discussion of premature vascular disease in the rehabilitation patient is followed by a short review of the clinical detection of, and potential therapy for, hyperhomocysteinemia.