Introduction: Marfan syndrome (MFS) is an autosomal dominant disorder of connective tissue with variable manifestations involving the cardiovascular system, ocular, musculoskeletal and other systems. Cardiovascular involvement places high risk of morbidity and mortality in individuals with MFS. Neurovascular consequence is an established complication and the multi-systems involvement in MFS critically impact recovery course and outcome.

Method: Descriptive case report to highlight the complexities and challenges of recovery and rehabilitation of a young individual with MFS and stroke.

Case Report: A 22-year old gentleman with MFS was referred for inpatient stroke rehabilitation. Due to MFS, he has tall stature, arachnodactyly, joint hyperlaxities, kyphoscliosis and bilateral ectopia lentis with postsurgical aphakia. He developed massive right middle cerebral territory infarct after Bentall procedure for aortic valve and ascending aorta disease. Post-operative period was complicated with recurrent pericardial tamponade. The stroke resulted in dense left hemiplegia, left homonymous hemianopia, left visual neglect, with concurrent post-stroke depression.
Rehabilitation was challenging due to the compromised cardiovascular status and dense weakness with premorbid joint hyperlaxities. Tall stature and musculoskeletal deformity impacted his balance and stability. Visual-related complications further limited his overall function. He endured a prolonged interdisciplinary stroke rehabilitation phase, with strict cardiac precautions.  He demonstrated progressive improvement and became independent within 6 months. At 2 and 3-year follow up, he remained well and successfully achieved community reintegration.
Conclusion: Marfan syndrome is a connective tissue disease with multi-systems involvement. Ischemic stroke as a neurovascular complication of MFS pose tremendous recovery challenge. Individually designed rehabilitation program is important, with resultant meaningful outcome.

ISCHEMIC STROKE AS A NEUROVASCULAR COMPLICATION IN A YOUNG INDIVIDUAL WITH MARFAN SYNDROME: A RECOVERY AND REHABILITATION CHALLENGE