Successful thrombolysis in essential thrombocythemia-related acute ischaemic stroke

Abstract

Essential thrombocythemia (ET)-related acute ischaemic stroke (AIS) may account for approximately 0.25%-0.5% of all ischaemic strokes. If left undiagnosed and untreated, patients with ET carry an increased risk of recurrent thrombosis involving major organs including the brain. We report an interesting case of a 67-year-old man, who was successfully thrombolysed for AIS resulting from ET. He presented with sudden onset of left-sided hemiparesis with a left-ventricular clot. His subsequent investigations including positive JAK2 V617F mutation confirmed the diagnosis of ET. He made a significant recovery with thrombolysis, anticoagulation, antiplatelet and hydroxyurea. A fear of post-thrombolytic haemorrhagic complications appears the major reason for the lack of reports of thrombolysis in ET-related AIS. Although the diagnosis of ET was confirmed on subsequent investigations, successful thrombolysis in our case provides preliminary evidence that ET-related AIS cases can undergo successful thrombolysis using tenecteplase. To date, ours is only the second case of ET-related AIS being thrombolysed.

Keywords: drugs: CNS (not psychiatric); neurology; stroke.

Figure 1

NCCT brain, 2D Echo and bone marrow biopsy images of the patient. NCCT scan of the brain obtained before (A) and 24 hours after (B) thrombolysis, showing the reduction in infarct size without haemorrhagic complication. (C) 2D Echo image showing LV clot. (D) H&E stain of bone marrow biopsy showing the presence of megakaryocytes. (E) H&E stain of bone marrow aspiration showing hypercellularity of bone marrow. 2D Echo, two-dimensional echocardiography; NCCT, non-contrast CT; LV, left-ventricular.