Acute multiple cerebral infarction combined with cerebral microhemorrhage in Polycythemia vera: A case report

Abstract

Polycythemia vera (PV) is one of the rare causes of cerebrovascular disease, whose common manifestations in the nervous system are cerebral infarction and transient ischemic attack. A number of cases of PV patients with bleeding complicated with subdural hemorrhage or cerebral hemorrhage have been previously reported. However, sometimes PV patient with complicated cerebral hemorrhage and lower extremity venous thrombosis have been admitted to the People's Hospital of Liaoning Province. The present case study reports on a patient with acute multiple cerebral infarction with cerebral micro-hemorrhage associated with PV, who was not treated with anti-thrombosis treatment. After bloodletting treatment and hydroxyurea treatment, the patients condition was stable and they were discharged. A possible mechanism of infarction is that PV may cause abnormal proliferation of red blood cells, white blood cells and platelets in the circulation, resulting in an increase of blood viscosity and reduction of blood flow velocity. Platelet deficiency may cause abnormal blood coagulation function, which may be the reason for the blood and thrombotic diseases in patients with PV.

Keywords: cerebral; infarction; microhemorrhage; polycythemia vera.

Figure 1.

Computed tomograms of the head a day after admission. (A) Multiple dot-like and flaky low-density changes were visible in the left occipital lobe and basal ganglia. The site adjacent to the left body of the lateral ventricle, (B) right frontal lobe and (C) parietal lobe.

Figure 2.

T1-weighted magnetic resonance image 2 days after admission. (A and B; obvious in B) Mixed signal intensities, mainly low signal intensity, in the round lesions adjacent to the left body of the lateral ventricle, (B) in line with the changes in the hemorrhagic transformation (type HI-1) post-infarction.

Figure 3.

T2-weighted magnetic resonance image 2 days after admission. (A and B) Multiple intracranial cerebral infarction was observed, in which the right frontal parietal lobe lesions exhibited multiple mass-like, discontinuous high-signal intensities and a low-signal ring in the periphery. (A and B) The low-signal ring indicated remote hemorrhage or hemosiderin deposition, mainly in the predominant area of the anterior cerebral artery. (C and D) Round high-signal intensity in the site adjacent to the left body of the lateral ventricle revealed slightly low signal changes, in line with the changes in the hemorrhagic transformation (type HI-1) post-infarction.

Figure 4.

A fluid-attenuated inversion recovery magnetic resonance image sequence 2 days after admission. The sequence was as follows: Multiple, dot-like, striped, and mass-like high-signal lesions in (A) the cerebellar hemisphere, (B and C) the left occipital lobe, (D-F) the thalamus and basal ganglia, (G and H) the site adjacent to the body of the lateral ventricle, (E) the frontal lobe, (J and L) the right frontal lobes, and (I and K) the parietal lobes. The lesions of the right frontal and parietal lobes presented as multiple mixed signals.

Figure 5.

Diffusion-weighted magnetic resonance image of the head 2 days after admission. Acute cerebral infarction, infarcts with supratentorial, infratentorial and bilateral multiple high-signal intensities. (A and B) The lesions of occipital lobe, (C-E) the lesions of thalamus and basal ganglia, (F and G) the lesions of the site adjacent to the body of the lateral ventricle, and (H-L) the lesions of right frontal and parietal lobes.

Figure 6.

Enhancement magnetic resonance image of the head 2 days after admission. A faint dot-like enhanced signal in (A and B) the right frontal parietal lobe and (C and D) the right frontal lobe was observed.

Figure 7.

Susceptibility-weighted angiography magnetic resonance image of the head 2 days after admission. (A-C) Multiple dot-like, (D and E) striped and (F) lumpy low-signal changes.