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Related Experiment Video

Updated: Jun 11, 2025

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"Y appearance" infarction: caused by essential thrombocythemia.

Shuyue Xiao1,2,3, Yan Ding1,2,3, Anding Xu4,5,6

  • 1Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, 510630, China.

Thrombosis Journal
|October 7, 2024
PubMed
Summary

Essential thrombocythemia (ET) can rarely cause bilateral medial medullary infarction ("Y appearance" stroke). Long-term tirofiban therapy improved symptoms in a patient with poorly controlled ET and this rare stroke subtype.

Keywords:
"Y appearance" infarctionBilateral medial medullary infarctionEssential thrombocythemiaTirofiban

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Area of Science:

  • Neurology
  • Hematology
  • Vascular Medicine

Background:

  • Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by excessive platelet production.
  • ET is a rare cause of ischemic stroke (IS), a condition involving blood clot formation.
  • Bilateral medial medullary infarction (BMMI), or "Y appearance" infarction, is a rare IS subtype with a poor prognosis.

Purpose of the Study:

  • To report a rare case of "Y appearance" infarction in a patient with essential thrombocythemia.
  • To discuss the management and outcome of this specific clinical presentation.

Main Methods:

  • Case report of a 43-year-old male with a history of poorly controlled ET.
  • Diagnosis confirmed by "Y appearance" infarction on head MRI.
  • Treatment involved initial intravenous tirofiban, followed by oral aspirin, then a switch back to prolonged intravenous tirofiban.

Main Results:

  • The patient presented with neurological symptoms including dizziness, dysphagia, and dysarthria.
  • Initial treatment with aspirin led to symptom worsening.
  • Prolonged tirofiban therapy resulted in significant symptom improvement, with residual mild limb numbness at 9-month follow-up.

Conclusions:

  • Essential thrombocythemia can be a rare cause of bilateral medial medullary infarction.
  • Long-term intravenous tirofiban may be beneficial in managing such complex cases, despite standard treatment protocols.
  • This case highlights the importance of individualized treatment strategies for rare stroke subtypes in patients with myeloproliferative neoplasms.