Neuroimaging findings of hypercoagulable states: A case report on polycythemia vera (PV)

Vaso-occlusive events leading to neurological complications are a common cause of morbidity and mortality in Polycythemia Vera (PV). Low prevalence and unfamiliarity of clinicians and radiologists to the neurological manifestations and radiological findings often result in delayed diagnosis of this potentially fatal disease. Awareness of a radiologist to the imaging findings of PV and other hypercoagulable states and their full spectrum of presentation is essential for the prevention of neurological complications. There are not many examples of neurological complication of PV. Here, we report a case of a 58-year-old male who presented with stroke. Initial neuroimaging revealed hyperdense dural venous sinuses, multifocal and multi-territorial synchronous, and metasynchromous ischemic infarctions. Prompt laboratory work-up revealed high hematocrit and low serum erythropoietin levels suggesting PV, which was confirmed on bone marrow biopsy.