Late onset buerger's disease with multiple cerebral infarcts

The first case of late onset Buerger's Disease with synchronous cerebral involvement is reported. A 57-year-old male, who was a heavy smoker, presented with sudden onset right limb numbness. Physical examination showed cross-over numbness on the left side of his face and right side of his trunk, left homonymous hemianopsia and extra-ocular muscle limitation. The brain MRI showed multiple new infarcts in the cerebellum, occipital lobe and left thalamus. Cyanosis of the digits of the left hand was also discerned, with progression accompanied by pain and repeated episodes of biphasic color changes indicating Raynaud's phenomenon. The angiography showed stenosis at the left distal ulnar and radial arteries of the wrist, and collateral vessels from the anterior interosseous artery. Serological study showed no evidence of autoimmune disease. The patient was advised to stop smoking and medication was also given. His pain and cyanosis gradually improved within 1 week. The clinical course, imaging results and laboratory study of this unique case is demonstrated herein.