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Published on: November 6, 2012
A case report of cerebral infarction caused by polycythemia vera
Shan Ren1, Fang Gao1, Zhigang Chen1
1Department of Neurology.
Rationale:
Polycythemia vera (PV) is a cloned erythrocytotic disease manifested by high proliferation and apoptosis in the bone marrow. The clinical symptoms of PV are occult. In practice, patients with cerebral infarction caused by PV are prone to misdiagnosis and missed diagnosis.
Patient Concerns:
Here, we report a misdiagnosis of PV leading to cerebral infarction. The patient was a middle-aged woman who was diagnosed with acute cerebral infarction in the outpatient hospital. After treatment, the patient still had left hemiplegia, dizziness and other symptoms and was admitted to our hospital.
Diagnosis:
We did not find sufficient evidence of atherosclerotic processes in the brain infarction. However, the patient's signs and laboratory examination indicated a high suspicion of PV. A series of further examinations confirmed the final diagnosis.
Interventions:
Bone marrow suppression medications (oral hydroxyurea and subcutaneous injection of interferon) were given and subsequent prevention of cerebral infarction was implemented.
Outcomes:
Routine blood reexamination was normal and no further cerebral infarction occurred.
Lessons:
Patients with acute cerebral infarction should be considered comprehensively, and rare causes should not be ignored. It is crucial that PV be diagnosed and treated as early as possible, which can significantly improve the prognosis of patients.
Insights
Polycythemia vera (PV) can cause cerebral infarction and is often misdiagnosed. Early diagnosis and treatment of PV are crucial for preventing recurrent strokes and improving patient outcomes.
Area of Science:
- Hematology
- Neurology
Background:
- Polycythemia vera (PV) is a myeloproliferative neoplasm characterized by excessive red blood cell production.
- PV often presents with subtle symptoms, leading to diagnostic challenges, particularly when complicated by cerebrovascular events.
Observation:
- A middle-aged woman presented with symptoms suggestive of acute cerebral infarction, initially misdiagnosed.
- Despite initial treatment, persistent neurological deficits prompted further investigation, revealing underlying Polycythemia vera.
- Diagnostic workup excluded atherosclerosis as the primary cause of cerebral infarction, highlighting the importance of considering hematological disorders.
Findings:
- Bone marrow examination and laboratory tests confirmed Polycythemia vera as the underlying cause of cerebral infarction.
- Treatment with hydroxyurea and interferon effectively managed PV and prevented further thrombotic events.
Implications:
- This case underscores the necessity of a comprehensive diagnostic approach for cerebral infarction, including evaluation for rare causes like PV.
- Timely diagnosis and management of Polycythemia vera are critical for improving neurological outcomes and preventing recurrent ischemic events.
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