A case report of cerebral infarction caused by polycythemia vera

Abstract

Rationale: Polycythemia vera (PV) is a cloned erythrocytotic disease manifested by high proliferation and apoptosis in the bone marrow. The clinical symptoms of PV are occult. In practice, patients with cerebral infarction caused by PV are prone to misdiagnosis and missed diagnosis.

Patient concerns: Here, we report a misdiagnosis of PV leading to cerebral infarction. The patient was a middle-aged woman who was diagnosed with acute cerebral infarction in the outpatient hospital. After treatment, the patient still had left hemiplegia, dizziness and other symptoms and was admitted to our hospital.

Diagnosis: We did not find sufficient evidence of atherosclerotic processes in the brain infarction. However, the patient's signs and laboratory examination indicated a high suspicion of PV. A series of further examinations confirmed the final diagnosis.

Interventions: Bone marrow suppression medications (oral hydroxyurea and subcutaneous injection of interferon) were given and subsequent prevention of cerebral infarction was implemented.

Outcomes: Routine blood reexamination was normal and no further cerebral infarction occurred.

Lessons: Patients with acute cerebral infarction should be considered comprehensively, and rare causes should not be ignored. It is crucial that PV be diagnosed and treated as early as possible, which can significantly improve the prognosis of patients.

Figure 1

MRI shows acute cerebral infarction in right side of basal ganglia and lateral ventricle. MRI = magnetic resonance imaging.

Figure 2

Bone marrow pathology shows hyperplasia of bone marrow.

Figure 3

Immunotyping shows increased CD64 expression and abnormal phenotype.

Figure 4

Chromosome examination (G band) shows 46, XX[20] abnormality.