Transient Spinal Cord Ischemia as Presenting Manifestation of Polycythemia Vera

Abstract

Spinal arterial vascularization is supplied by a large anastomotic net, making spinal ischemic events far less common than ischemic cerebral strokes. Polycythemia vera, due to blood hyperviscosity and activated platelet aggregation, is associated with a higher risk of arterial and venous thrombotic events. We report a patient with spinal cord transient ischemic attacks, a rarely presenting manifestation, and polycythemia vera, which highlights the thrombotic potential of this disease, and the requirement of exhaustive diagnostic workout of a spinal ischemic event.

A case of spinal cord infarction caused by polycythemia vera

“…Polycythemia vera can also cause recurrent ischemic events, as seen in our current patient. 2 The diagnosis of polycythemia vera entered a new era with the identification of the Janus kinase 2 mutation in 2005. 3 The diagnostic criteria for polycythemia vera were revised by the World Health Organization (WHO) in 2008.…”

“…3 It is well established that polycythemia vera is associated with a higher risk of both arterial and venous thrombosis. 2 This disorder may also cause myocardial infarction, splenic infarction, cerebral infarction and other systemic thromboembolisms. Polycythemia vera also rarely causes aortic thrombus.…”

“…1,2 Major causes of spinal cord infarction include therapeutic embolization and atherosclerotic diseases affecting the aorta. 1 Myeloproliferative disorders, such as polycythemia vera, are a rare cause of acute spinal cord infarction.…”

Unusual Neurologic Manifestations of a Patient with Cyanotic Congenital Heart Disease after Phlebotomy

“…The more serious presentation of polycythemia is thrombotic event inclusive of cerebrovascular accident (CVA) and transient ischemic attacks (TIA) which are usually manifested [ 3 ] as symptoms or signs of hemiparesis and/or hemisensory defects, cortical blindness, aphasia, dysarthria, dysphagia ataxia, or drop attacks, distinguishing thrombotic event from hyperviscosity [ 5 ].…”

Vertebral artery thrombosis: a rare presentation of primary polycythaemia

“…A case of spinal cord ischaemia as a presenting feature of PV has been published 17. However, to the best of our knowledge, vertebral thrombosis as the initial presentation of an MPN has not previously been published.…”