Bilateral visual loss and cerebral infarction after spleen embolization in a trauma patient with idiopathic thrombocytopenic purpura

Abstract

Rationale:Splenic artery embolization (SAE) is a common procedure in trauma patients with blunt splenic injuries. We report a case of acute ischemic stroke following orthopedic surgery in a patient with post-SAE reactive thrombocytosis.Patient concerns:A 37-year-old woman with idiopathic thrombocytopenic purpura (ITP) suffered from multiple trauma scheduled for open reduction and internal fixation for right tibial and left radius fracture five days after SAE. The patient did not have any thromboembolic complications, although the platelet counts increased from 43 × 109/L to 568 × 109/L within two days after SAE. Surgery was completed under general anesthesia with tracheal intubation without complications. The patient complained of visual loss followed by limb weakness on the fourth and eighth hour postoperatively.Diagnoses:Magnetic resonance imaging (MRI) of head demonstrated ischemic change over bilateral basal ganglia, and occipital areas, suggesting the diagnosis of cortical blindness.Interventions:To suppress platelet count and avoid platelet hyper-aggregation, anti-platelet drug (i.e., oral aspirin 100 mg daily), hydration, and hydroxyurea (i.e., 20 mg/kg daily) were used for the treatment of reactive thrombocytosis.Outcomes:Although right-sided hemiparesis persisted, the patient reported mild visual recovery. She was discharged four months after SAE with active rehabilitation.Lessons:Our report highlights an increased risk of acute arterial thromboembolic events in patients with reactive thrombocytosis, especially those undergoing surgery.

Visual stimulation rehabilitation for cortical blindness after vertebral artery interventional surgery: A case report and literature review

“…We searched the PubMed database for clinical studies conducted in patients with complete cortical blindness due to various causes over the past 10 years and summarized in Table 1 . We focused on the type of neurophysiological examination performed, treatment modality, and outcomes [ 7 , 8 , 15 , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] ]. The search strategy was “Blindness, cortical/rehabilitation”[Mesh] OR “Blindness, Cortical/therapy”[Mesh].…”

Treatment of Acute Ischaemic Stroke and Concomitant Multiple Arterial Splanchnic Thromboses in a Patient with Immune Thrombocytopenia on Thrombopoietin Agonist: A Case Report

“…Twenty-four articles were eligible and were included in the review [ 1 , 2 , 5 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. We identified three case reports [ 1 , 9 ] and three review articles [ 1 , 9 , 10 ] on AIS treatment with IVT in patients with ITP.…”

“…We identified three case reports [ 1 , 9 ] and three review articles [ 1 , 9 , 10 ] on AIS treatment with IVT in patients with ITP. Thirteen articles addressed thrombotic complications in ITP patients [ 5 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], and eight articles detailed the thrombotic complications of TPO treatment in ITP patients [ 2 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ].…”

Butylphthalide inhibits nerve cell apoptosis in cerebral infarction rats via the JNK/p38 MAPK signaling pathway

“…Cerebral infarction is a relatively common critical disease in clinic, which may induce hypoxic-ischemic injury of brain tissues and neurons to cause serious damage to the nervous system. For patients with cerebral infarction, the central nervous system injury induced by the disease brings about severe consequences, and the patients often experience limb motor dysfunction, speech disorder and even the risk of death ( 1 , 2 ). Therefore, cerebral infarction seriously threatens the life, health and quality of life of human beings and brings heavy economic burdens to the patients' families and society.…”