[Multiple cerebral infarctions associated with left vertebral artery dissection in a patient with polycythemia vera]

We report a case of vertebral artery dissection associated with polycythemia vera (PV). A 66-year-old woman with PV diagnosed 11 years earlier presented with dizziness, nausea, and gait disturbance. Cerebral MRI revealed multiple bilateral cerebral infarctions caused by vertebral artery dissection. Laboratory tests showed hematocrit of 43% but marked leukocytosis (74,000/µl) and thrombocytosis (112×10⁴/µl). The patient received cytoreductive therapy with hydroxycarbamide, combined with dual antiplatelet therapy. Additionally, to secure adequate blood flow, a stent was placed in the left vertebral artery, leading to gradual neurological improvement. In myeloproliferative neoplasms (MPN), thrombotic and hemorrhagic events are the predominant complications. Recently, JAK2 V617F mutation in vascular endothelial cells of patients with MPN has been documented, suggesting a potential association between MPN and arterial dissection or dissecting aneurysm. Although rare, such vascular complications can be life-threatening and should be recognized as clinically significant.