ACUTE EMBOLIC CEREBRAL ISCHEMIA AS AN INITIAL PRESENTATION OF POLYCYTHEMIA VERA

Abstract

Patients with Polycythemia vera (PV) are at high risk for vaso-occlusive events including cerebral ischemia. Ischemic stroke may be the first presenting symptom of PV in 15% or more of those affected. It had been previously assumed that cerebral ischemic events were due to increased blood viscosity and platelet activation within the central nervous system arterial vessels. However, there are now a few isolated case reports of probable micro-embolic events originating from outside of the brain.

Case report: A 45-year old man presented with left sided hemiperesis (recovered within 12 hours) in our Medicine OPD. Hematologic investigation revealed a hyperviscous state (Hemoglobin 21.9gm% and PCV 66%). Acute infarction in right corona radiata and basal ganglia was found in magnetic resonance imaging(MRI) of brain. Although unusual, acute embolic cerebral ischemia may be an initial presentation of PV. The etiology of stroke in polycythemic patients is likely to be multifactorial. All clinicians involved in the care of stroke patients should be aware of the association of PV and ischemic stroke.