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[Is it CNS vasculitis? Essential thrombocythaemia with a normal platelet count].

Lisbeth Rosholm Comstedt1, Peter Junker

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A myeloproliferative disorder can cause unexplained ischemic central nervous system (CNS) events. Early consideration is vital, even with normal initial blood counts, as seen in this transient ischemic attack case.

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Area of Science:

  • Neurology
  • Hematology
  • Oncology

Background:

  • Transient ischemic attacks (TIAs) can present with diverse underlying causes.
  • Cerebral vasculitis is a potential diagnosis for ischemic central nervous system (CNS) events.

Observation:

  • A 58-year-old woman presented with TIAs, initially suspected to be due to cerebral vasculitis.
  • Her blood chemistry remained normal for nine months post-admission.
  • She subsequently developed significant thrombocytosis (platelet count > 600 x 10(9)/L).

Findings:

  • Bone marrow biopsy revealed myeloproliferative changes.
  • Genetic analysis identified Janus Kinase-2 (JAK2) mutation, V617F.
  • Over-expression of the polycythaemia rubra vera-1 (PRV-1) gene was confirmed.

Implications:

  • This case highlights myeloproliferative disorders as a differential diagnosis for unexplained ischemic CNS manifestations.
  • It underscores the importance of considering hematological evaluation in patients with neurological symptoms, even with initially normal blood counts.
  • Timely diagnosis of myeloproliferative neoplasms can potentially guide management and improve patient outcomes.