Ischemic Stroke as First Manifestation of Essential Thrombocythemia

Arboix, Adrià; Besses, Carles; Acín, Pilar Aguado; Massons, J; Florensa, Lourdes; Oliveres, Montserrat; Sans-Sabrafén, J

doi:10.1161/01.str.26.8.1463

Cited by 64 publications

(26 citation statements)

References 14 publications

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“…Actually, both in the present study and in other series, severe thrombotic events were observed in some patients who had only moderate thrombocytosis. 10,24,25 The present study is in support of the general agreement that lowering the platelets with therapeutic agents would be indicated in high-risk ET patients with either major thrombotic or hemorrhagic complications or an age above 60 years. 5,22,26,27 However, two questions remained to be solved in prospective clinical trials.…”

Section: Discussionsupporting

confidence: 84%

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1999

Leukemia

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To determine the clinicohematological factors predictive for the appearance of major vascular complications (MVC) in patients with essential thrombocythemia (ET), 148 consecutive such patients were retrospectively assessed for the development of MVC during a median follow-up of 58.5 months. Seventy-seven patients had vascular risk factors, and 37 a history of MVC at ET diagnosis. Forty-nine MVC were registered in 33 patients during the follow-up period. The actuarial probability of MVC was 27% at 6 years in the whole series, 35.6% for patients above 60 years, and 21.4% for patients younger than 60 years, whereas only one of the 36 patients younger than 45 years had MVC. At multivariate analysis, age Ͼ60 years, history of major ischemia and hypercholesterolemia were the variables associated with an increased MVC risk. These results suggest that all ET patients above 60 years should be treated, whereas in younger patients treatment decisions should be primarily based on the existence of risk factors for MVC.

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Section: Discussionsupporting

confidence: 84%

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1999

Leukemia

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“…4,5 At disease onset, neurologic events in our patient were attributed to ET. However, the recurrence of ischemic episodes once platelet counts returned to normal led us to consider other diagnostic possibilities, and the angiographic pattern allowed the diagnosis of moyamoya.…”

Section: Discussionmentioning

confidence: 83%

Moyamoya Syndrome in an Adolescent With Essential Thrombocythemia

Kornblihtt

Cocorullo

Miranda

et al. 2005

Stroke

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Background-Essential thrombocythemia (ET) is a chronic myeloproliferative disorder with increased frequency of thrombotic events, including transient ischemic attacks (TIAs) and stroke. Moyamoya syndrome is a rare cerebrovascular disease characterized by progressive occlusion of intracerebral arteries with a typical "puff of smoke" angiographic pattern. We report the development of moyamoya syndrome in a patient with ET. Case Description-The patient is an 18-year-old female who presented at age 13 with recurrent TIAs. Persistent thrombocytosis was found, a diagnosis of ET was made, and treatment with anagrelide was started. Despite normal platelet counts, she experienced recurrent TIAs and stroke. Severe stenosis of the supraclinoid segment of the left internal carotid artery (LICA) and abnormal collateral vessels were found, and moyamoya syndrome was diagnosed on the basis of the characteristic angiographic appearance. An intracranial stent was placed in the LICA, and since then, she has had an uneventful outcome after a 46-month follow-up. Conclusion-To our knowledge, the development of moyamoya phenomenon has not been reported in ET, and the relationship between these 2 disorders remains unclear. Besides, this is the first intracranial carotid stent implanted successfully in a patient with moyamoya. (Stroke. 2005;36:e71-e73.)

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“…This has led to reportorial bias with the publication and uncritical acceptance of anecdotal and incompletely studied case reports of unexpected thrombotic events occurring in association with thrombocytosis. 242,[341][342][343] These, unfortunately, not only fail to establish a cause and effect relationship but also merely provide a numerator without any denominator. As an example, when the factors associated with hepatic vein thrombosis were evaluated retrospectively, it was found that this event was actually preceded by a high hematocrit level and followed by thrombocytosis.…”

Section: Fact Versus Fictionmentioning

confidence: 99%