Case Report
Cerebral Infarct in a Patient with a History of Systemic Arterial and Venous Thrombosis from Essential Thrombocythemia

https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.01.005Get rights and content

Although essential thrombocythemia (ET) may involve thrombotic complications, including arterial or venous thrombosis, there are no reports of major vascular complications, including both arterial and venous thrombosis, in a patient with ET. We report on a patient with a cerebral infarction affecting the right lateral thalamus and a stenotic lesion of the right posterior cerebral artery. This arterial thrombotic event may be related to ET, which was based on results of a bone marrow biopsy specimen. The patient had experienced previous events of thrombosis, splenic infarction with venous thrombosis, and myocardial infarction. The cause of recurrent ischemic events involving both arterial and venous systems may be sustained elevation of platelet counts. Previous thrombosis is an established risk factor for rethrombosis in patients with ET. Efficient cytoreductive therapy with an antiplatelet agent should be considered for the prevention of recurrent thrombosis.

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Case Report

A 46-year-old man was admitted because of the sudden development of a tingling sensation in his left face, arm, and leg. The patient had first been seen at our hospital 8 years earlier because of abdominal pain. A computed tomographic scan of the abdomen revealed multiple splenic infarctions and thrombosis in the superior mesenteric, splenic, and portal veins (Fig 1). Repeated blood tests revealed high platelet counts (1,000,000/μL). A diagnosis of ET was made based on the results of a bone

Discussion

Our patient experienced 3 major thrombotic events—splenic infarction with splanchnic venous thrombosis, myocardial infarction, and cerebral infarction—over an 8-year period. He had 2 additional arterial thrombotic events after the occurrence of the first venous thrombosis. A recent report found that both arterial and venous thrombotic complications in ET were extremely rare (7/891; 0.78%) after a median follow-up of 6.2 years.2 In addition, recurrent thrombosis involved 3 different sites: the

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