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

Abstract

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.

Digital gangrene: can be the first manifestation of essential thrombocythemia? a case report

“…One year after being discharged, his condition showed signs of improvement and stability. This instance implies that ET can both induce very diverse strokes and act as a risk factor for strokes 12 . Our report was unique as the patient was unaware of his illness and since, even with aspirin therapy, the patient’s initial sign of the disease was digital gangrene.…”

Hematologic Disorders and the Nervous System

“…Similar to other myeloproliferative disorders, ET may be complicated by intravascular thrombus in 10% to 20% of cases, contributing to higher morbidity and mortality 21,27 . Cerebrovascular manifestations of ET include arterial ischemic stroke, cerebral venous sinus thrombosis, intraparenchymal hemorrhage, and convexal subarachnoid hemorrhage 21,28-30 . The pattern of arterial ischemic stroke in ET is variable, with subtypes ranging from intracranial large and small artery occlusions to embolic strokes and watershed infarctions 21,31 …”

“…21,27 Cerebrovascular manifestations of ET include arterial ischemic stroke, cerebral venous sinus thrombosis, intraparenchymal hemorrhage, and convexal subarachnoid hemorrhage. 21,[28][29][30] The pattern of arterial ischemic stroke in ET is variable, with subtypes ranging from intracranial large and small artery occlusions to embolic strokes and watershed infarctions. 21,31 When evaluating a patient with abnormally elevated platelets, differentiating ET from secondary causes of thrombocytosis, including systemic inflammation…”