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Concomitant Cerebral Venous Thrombosis and Intracranial Hemorrhages in Presentation of a Patient with Secondary Polycythemia: A Case Report

Patient: Male, 35-year-old Final Diagnosis: Cerebral venous thrombosis • secondary polycythemia • subarachnoid hemorrhage Symptoms: Acute headache • hemiparesis Clinical Procedure: Magnetic resonance angiography of head and neck • magnetic resonance venography of head Specialty: Neurology OBJECTIVE:...

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Autores principales: Fahrurriza, Hiztien, Gofir, Abdul, Setyawan, Tommy Rachmat, Hutajulu, Susanna Hilda, Nugroho, Dhite Bayu, Rochmah, Mawaddah Ar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10584197/
https://www.ncbi.nlm.nih.gov/pubmed/37838828
http://dx.doi.org/10.12659/AJCR.941507
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author Fahrurriza, Hiztien
Gofir, Abdul
Setyawan, Tommy Rachmat
Hutajulu, Susanna Hilda
Nugroho, Dhite Bayu
Rochmah, Mawaddah Ar
author_facet Fahrurriza, Hiztien
Gofir, Abdul
Setyawan, Tommy Rachmat
Hutajulu, Susanna Hilda
Nugroho, Dhite Bayu
Rochmah, Mawaddah Ar
author_sort Fahrurriza, Hiztien
collection PubMed
description Patient: Male, 35-year-old Final Diagnosis: Cerebral venous thrombosis • secondary polycythemia • subarachnoid hemorrhage Symptoms: Acute headache • hemiparesis Clinical Procedure: Magnetic resonance angiography of head and neck • magnetic resonance venography of head Specialty: Neurology OBJECTIVE: Unusual clinical course BACKGROUND: Cerebral ischemia and hemorrhages were reported to be the main complications of polycythemia vera (PV). The relationship between PV and increased risk of the cerebrovascular events has been established. Some patients with secondary polycythemia have thromboembolic events comparable to those of PV. However, secondary polycythemia that leads to cerebrovascular events is uncommon. CASE REPORT: A 35-year-old man without any prior medical history presented with mild clinical acute ischemic stroke and polycythemia. The patient then showed worsening neurological deficits that were later attributed to the concurrent cerebral venous thrombosis, which led to malignant cerebral infarction with hemorrhagic transformation, and subarachnoid hemorrhage. His polycythemia appeared to be secondary to bacterial infection. The treatments for the secondary polycythemia were first phlebotomy and intravenous hydration, followed by intravenous broad-spectrum antibiotics. PV was excluded because the JAK2 V617F mutation was absent, the patient’s peripheral blood smear suggested secondary polycythemia due to bacterial infection, and there were improvements in hemoglobin, erythrocyte count, and hematocrit after intravenous antibiotics. At the 1-month follow-up, he was moderately dependent, and hemoglobin, erythrocyte count, and hematocrit were within normal limits, without receiving any further phlebotomy or cytoreductive agents. CONCLUSIONS: This case highlights the plausible causation of secondary polycythemia that could lead to concomitant cerebral thrombosis and hemorrhagic events. The diagnosis of cerebral venous thrombosis should be considered in a patient who presents with headache, focal neurological deficits, polycythemia, and normal head computed tomography scan.
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spelling pubmed-105841972023-10-19 Concomitant Cerebral Venous Thrombosis and Intracranial Hemorrhages in Presentation of a Patient with Secondary Polycythemia: A Case Report Fahrurriza, Hiztien Gofir, Abdul Setyawan, Tommy Rachmat Hutajulu, Susanna Hilda Nugroho, Dhite Bayu Rochmah, Mawaddah Ar Am J Case Rep Articles Patient: Male, 35-year-old Final Diagnosis: Cerebral venous thrombosis • secondary polycythemia • subarachnoid hemorrhage Symptoms: Acute headache • hemiparesis Clinical Procedure: Magnetic resonance angiography of head and neck • magnetic resonance venography of head Specialty: Neurology OBJECTIVE: Unusual clinical course BACKGROUND: Cerebral ischemia and hemorrhages were reported to be the main complications of polycythemia vera (PV). The relationship between PV and increased risk of the cerebrovascular events has been established. Some patients with secondary polycythemia have thromboembolic events comparable to those of PV. However, secondary polycythemia that leads to cerebrovascular events is uncommon. CASE REPORT: A 35-year-old man without any prior medical history presented with mild clinical acute ischemic stroke and polycythemia. The patient then showed worsening neurological deficits that were later attributed to the concurrent cerebral venous thrombosis, which led to malignant cerebral infarction with hemorrhagic transformation, and subarachnoid hemorrhage. His polycythemia appeared to be secondary to bacterial infection. The treatments for the secondary polycythemia were first phlebotomy and intravenous hydration, followed by intravenous broad-spectrum antibiotics. PV was excluded because the JAK2 V617F mutation was absent, the patient’s peripheral blood smear suggested secondary polycythemia due to bacterial infection, and there were improvements in hemoglobin, erythrocyte count, and hematocrit after intravenous antibiotics. At the 1-month follow-up, he was moderately dependent, and hemoglobin, erythrocyte count, and hematocrit were within normal limits, without receiving any further phlebotomy or cytoreductive agents. CONCLUSIONS: This case highlights the plausible causation of secondary polycythemia that could lead to concomitant cerebral thrombosis and hemorrhagic events. The diagnosis of cerebral venous thrombosis should be considered in a patient who presents with headache, focal neurological deficits, polycythemia, and normal head computed tomography scan. International Scientific Literature, Inc. 2023-10-15 /pmc/articles/PMC10584197/ /pubmed/37838828 http://dx.doi.org/10.12659/AJCR.941507 Text en © Am J Case Rep, 2023 https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Articles
Fahrurriza, Hiztien
Gofir, Abdul
Setyawan, Tommy Rachmat
Hutajulu, Susanna Hilda
Nugroho, Dhite Bayu
Rochmah, Mawaddah Ar
Concomitant Cerebral Venous Thrombosis and Intracranial Hemorrhages in Presentation of a Patient with Secondary Polycythemia: A Case Report
title Concomitant Cerebral Venous Thrombosis and Intracranial Hemorrhages in Presentation of a Patient with Secondary Polycythemia: A Case Report
title_full Concomitant Cerebral Venous Thrombosis and Intracranial Hemorrhages in Presentation of a Patient with Secondary Polycythemia: A Case Report
title_fullStr Concomitant Cerebral Venous Thrombosis and Intracranial Hemorrhages in Presentation of a Patient with Secondary Polycythemia: A Case Report
title_full_unstemmed Concomitant Cerebral Venous Thrombosis and Intracranial Hemorrhages in Presentation of a Patient with Secondary Polycythemia: A Case Report
title_short Concomitant Cerebral Venous Thrombosis and Intracranial Hemorrhages in Presentation of a Patient with Secondary Polycythemia: A Case Report
title_sort concomitant cerebral venous thrombosis and intracranial hemorrhages in presentation of a patient with secondary polycythemia: a case report
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10584197/
https://www.ncbi.nlm.nih.gov/pubmed/37838828
http://dx.doi.org/10.12659/AJCR.941507
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