Repeated Episodes of Ischemic Stroke over a Short Period in a Patient with Essential Thrombocythemia on Anticoagulant Therapy

Naganuma, Masaki; Isoda, Kazuya; Nishi, Shinsuke; Ito, Kiyotaka; Hirano, Teruyuki

doi:10.1016/j.jstrokecerebrovasdis.2012.07.003

Cited by 11 publications

(3 citation statements)

References 9 publications

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“…The etiologies of ischemic stroke caused by JAK2-V617F mutations reveal different patterns, such as microvascular disturbances, large vessel thrombosis, and arterial dissection. [10][11][12] In the present case, the first stroke event was attributed to thrombosis secondary to progressive intracranial arterial stenosis. However, the recurrent stroke event was attributed to various etiologies, including atherothrombosis and hemodynamic disturbance.…”

Section: Discussionmentioning

confidence: 54%

A Case of Recurrent Ischemic Stroke Involving Subacute, Progressive Intracranial Cerebral Arterial Sclerosis Prior to Diagnosis with JAK2-mutated Polycythemia Vera

Nezu

Aoki

Ochi

et al. 2015

Journal of Stroke and Cerebrovascular Diseases

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Section: Discussionmentioning

confidence: 54%

A Case of Recurrent Ischemic Stroke Involving Subacute, Progressive Intracranial Cerebral Arterial Sclerosis Prior to Diagnosis with JAK2-mutated Polycythemia Vera

Nezu

Aoki

Ochi

et al. 2015

Journal of Stroke and Cerebrovascular Diseases

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“…Watershed infarction, as observed in this case, is one of the most common stroke subtypes caused by ET 3 , 4 along with lacunar infarction, 5 punctate subcortical infarction, 6 and giant infarction. 7 Cerebral ischemia is the most common ischemic manifestation in ET cases. 8 Platelets play an important role in the process of thrombus formation (Figure 2).…”

Section: Discussionmentioning

confidence: 99%

Successive development of ischemic stroke and hemorrhagic stroke in a patient with essential thrombocythemia: a case report

2021

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Patients with essential thrombocythemia (ET) can experience hemorrhagic or ischemic vascular events. The prevention of these complications is challenging, and the overall risk of vascular events caused by ET is often overlooked. A 34-year-old man was admitted for a 10-day history of weakness and numbness in his right limbs. He had been diagnosed with ET in 2008 but had stopped receiving treatment half a year before admission. Physical examination showed a superficial sense of disturbance in the right limbs and decreased muscle strength in the right upper and lower limbs (4/5). His platelet count (459 × 109/L) was elevated. Magnetic resonance imaging showed acute watershed infarction, and he was treated successfully. However, he was readmitted for headache and left limb weakness 14 months later. A head computed tomography scan revealed spontaneous subdural hemorrhage. He underwent subdural hematoma removal and decompressive craniectomy. Surgery and pathological investigation revealed no venous sinus thrombosis or vascular malformation. His condition improved, and he exhibited a stable condition 1 year after discharge. Successive development of ischemic stroke and spontaneous subdural hemorrhage is rare in a patient with ET. This case suggests that ET is not only a risk factor for stroke but can also cause highly heterogeneous strokes.

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“…Patients with ET suffer repeated episodes of ischemic stroke or TIA without treatment, and thrombolysis with rt-PA in such patients has not been verified in a clinical trial, even though a case report has been published [ 14 ]. The combination of anticoagulant and cytoreductive therapy may be effective for ET patients with severe arterial stenosis [ 4 , 15 ]. Antiplatelets and cytoreductive therapies are effective and preventive strategies for ischemic events [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Complex intracranial vascular complications caused by essential thrombocythemia: a critical case report

Xie¹,

Geng²,

Yuan³

et al. 2020

BMC Neurol

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Background Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by elevated and dysfunctional platelets. ET can result in systemic thrombotic and hemorrhagic complications, and it’s a rare cause of stroke. The coexistence of multiple vascular lesions has seldom been reported in patients with essential thrombocythemia. Case presentation A young woman presented with isolated and persistent vertigo and vomiting. The CT scan indicated a hyperdense lesion in the right cerebellar hemisphere. No signs of cerebral artery malformation were observed in the CT angiography (CTA). Besides, the blood tests indicated an increase in platelet and white blood cell counts. The patient then suddenly developed a transient unconsciousness with left horizontal nystagmus when staring to the right. The subsequent cranial magnetic resonance imaging (MRI) scans indicated a diffuse and acute infarction of the pons and hemorrhage in the bilateral cerebellums. Further digital subtraction angiography (DSA) revealed a progressive and critical intracranial vertebral arterial occlusion. The patient’s clinical condition stabilized after cytoreductive therapy with interferon-α (IFN-α), even though endovascular and antiplatelet treatments were restricted because of the simultaneous presence of intracerebral hemorrhage (ICH) and ischemic stroke. A JAK2 V617F mutation was later detected through genetic testing, further confirming the diagnosis of ET. The patient was treated with a continuous regimen of IFN-α, and an antiplatelet treatment (aspirin) was added after ICH. The 1-year follow-up indicated normal platelet levels and no additional stroke event. Conclusions This case demonstrates that ET can be a rare cause of the cerebrovascular disease (CVD), even though the coexistence of ischemic and hemorrhagic complications. Underlying hematological system diseases should be taken into account when abnormal hemogram and CVD are concurrent in a patient. An early multidisciplinary diagnosis and intervention could significantly improve patient’s prognosis.

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Repeated Episodes of Ischemic Stroke over a Short Period in a Patient with Essential Thrombocythemia on Anticoagulant Therapy

Cited by 11 publications

References 9 publications

A Case of Recurrent Ischemic Stroke Involving Subacute, Progressive Intracranial Cerebral Arterial Sclerosis Prior to Diagnosis with JAK2-mutated Polycythemia Vera

A Case of Recurrent Ischemic Stroke Involving Subacute, Progressive Intracranial Cerebral Arterial Sclerosis Prior to Diagnosis with JAK2-mutated Polycythemia Vera

Successive development of ischemic stroke and hemorrhagic stroke in a patient with essential thrombocythemia: a case report

Complex intracranial vascular complications caused by essential thrombocythemia: a critical case report

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