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Case Reports
. 2021 Jul;12(3):601-602.
doi: 10.1055/s-0041-1729478. Epub 2021 May 5.

Polycythemia Vera Presenting as Hemorrhagic Stroke

Krishnan Balagopal  1 , Aju Mathew  2 , Ansa Grace Koshy  1 , Jerin Peter Jacob  1
Affiliations
Case Reports

Polycythemia Vera Presenting as Hemorrhagic Stroke

Krishnan Balagopal et al. J Neurosci Rural Pract. 2021 Jul.

Abstract

Patients with polycythemia vera are at high risk for vaso-occlusive events including cerebral ischemia and hemorrhage. Cerebral ischemic events are due to increased blood viscosity and platelet activation within the central nervous system arterial vessels. We present a case of a 65-year-old woman who presented to the emergency department with seizures followed by left-sided weakness. Hematologic investigations revealed a hyperviscous state, and magnetic resonance imaging (MRI) was consistent with bilateral hemorrhagic infarction. Genetic studies were positive for polycythemia vera mutation. Symptoms improved with phlebotomy and antiplatelet agents. Through this case, we aim to highlight polycythemia vera as a cause of hemorrhagic stroke and the importance of blood counts in the routine evaluation of the same.

Keywords: hemorrhagic stroke; hypercoagulable state; polycythemia vera.

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Conflict of interest statement

Conflict of interest None declared.

Figures

Fig. 1
Fig. 1
CT brain showing bilateral hemorrhagic infarction in the parieto-occipital lobes.
Fig. 2
Fig. 2
( A ) Diffusion-weighted imaging (DWI) and ( B ) apparent diffusion coefficient (ADC) images showing areas of restricted diffusion on DWI involving right thalamus, bilateral parieto-occipital lobes, and corresponding areas on ADC.
Fig. 3
Fig. 3
( A ) Diffusion-weighted imaging and ( B ) apparent diffusion coefficient images showing bilateral frontal and occipital infarcts.
Fig. 4
Fig. 4
T2/FLAIR (fluid-attenuated inversion recovery) images showing bilateral hemorrhagic infarcts involving parieto-occipital lobes.
Fig. 5
Fig. 5
( A ) Susceptibility-weighted imaging (SWI) images showing hemorrhagic areas in both parieto-occipital lobes. ( B ) Magnetic resonance angiography (MRA) showing hypoplastic right vertebral artery on MRA.
See this image and copyright information in PMC

References

    1. Spivak J L. Polycythemia vera. Curr Treat Options Oncol. 2018;19(02):12. - PubMed
    1. Lim Y, Lee J O, Kim S H et al.Prediction of thrombotic and hemorrhagic events during polycythemia vera or essential thrombocythemia based on leukocyte burden. Thromb Res. 2015;135(05):846–851. - PubMed
    1. Marchioli R, Finazzi G, Specchia G et al.CYTO-PV Collaborative Group. Cardiovascular events and intensity of treatment in polycythemia vera. N Engl J Med. 2013;368(01):22–33. - PubMed
    1. Gruppo Italiano Studio Policitemia . Polycythemia vera: the natural history of 1213 patients followed for 20 years. Ann Intern Med. 1995;123(09):656–664. - PubMed
    1. Levine R L, Wadleigh M, Cools J et al.Activating mutation in the tyrosine kinase JAK2 in polycythemia vera, essential thrombocythemia, and myeloid metaplasia with myelofibrosis. Cancer Cell. 2005;7(04):387–397. - PubMed

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