Fabry disease, rare X-linked disorder with deficient activity of alpha-galactosidase A, leads to a multiple organ failure caused by a progressive accumulation of the substrat globotriasocylceramide in cells. Peripheral nerve involvement, neuropathic pain and chronic acroparesthesiae, are the most frequently reported signs and often revealing the disease. They are secondary to the small nerve fibres (fibres 5), that explained the normality of electroneuromyography. Cochleovestibular and autonomic nervous system involvement appear later in the illness, aseptic meningitis are rare. Cerebrovascular events (stroke, transient ischaemic attack) are reported in 25% of patients, increasing with age. Affecting essentially the posterior circulation, their etiologies have to be clarified. MRI shows numerous silent lesions, increasing with age, mainly in small perforant arteries and pulvinar calcifications, due to on increase in cerebral perfusion with an impaired cerebral autoregulation, secondary to the glycosphingolipid storage in vascular endothelial cells. Enzyme replacement therapy could improve cerebral regional blood flow disturbances and painful neuropathy
